| NPI | 1518391580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C6430) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX LCDC 619) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 508697) | |
| 101YM0800X Counselor, Mental Health (Licence: TX LPC 9276) | |
| 101YM0800X Counselor, Mental Health (Licence: OR C6430) | |
| 1041C0700X Social Worker, Clinical (Licence: TX LMSW 16271) | |
| 106H00000X Marriage & Family Therapist (Licence: TX LMFT 580-574) | |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2022-05-20 |