NPI | 1548413727 |
---|---|
Former Name | JAMIE KELLY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2008032467) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 10800) |
Enumeration Date | 2008-10-31 |
Last Update Date | 2023-01-26 |