| NPI | 1487677803 |
|---|---|
| Former Name | TIFFANY LAREE THELIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |