NPI | 1457884371 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX LCDC 9007) |
106H00000X Marriage & Family Therapist (Licence: TX LPC 16268) | |
Enumeration Date | 2017-04-07 |
Last Update Date | 2020-06-10 |