| NPI | 1508109653 |
|---|---|
| Former Name | JESSICA LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C5461) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2023-11-28 |