| NPI | 1528021961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MO 2004033834) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: MO 2004033834) |
| 103TH0100X Psychologist Health Service (Licence: MO 2004033834) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2007-07-08 |