| NPI | 1467822023 |
|---|---|
| Former Name | RANDIE SHANE TOLLEFSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OH F1700018) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY 001248) |
| 106H00000X Marriage & Family Therapist (Licence: OH F.1700018) | |
| Enumeration Date | 2015-09-25 |
| Last Update Date | 2018-12-12 |