| NPI | 1518005313 |
|---|---|
| Former Name | KELLY CARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 0005475) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF50814) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2022-02-01 |