| NPI | 1487492104 |
|---|---|
| Former Name | LISA LARAE JOHNS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 73864) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 73864) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-07-17 |