| NPI | 1508387705 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WY LPC2162) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2023-04-18 |