| NPI | 1497138903 |
|---|---|
| Former Name | ELISE CAROLYN TISDALE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-16-24238) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2017-12-29 |