| NPI | 1528361334 |
|---|---|
| Former Name | BRANDI LYNN SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0005883) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 5883) |
| 101YM0800X Counselor, Mental Health (Licence: CO 0005883) | |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2021-10-27 |