| NPI | 1467148213 |
|---|---|
| Former Name | SHELLEY WATERMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2022049325) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 04107) |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2023-04-14 |