| NPI | 1487050639 |
|---|---|
| Former Name | AMANDA VICTORIA ELAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 84301) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MS PH3036) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2022-07-05 |