| NPI | 1548570583 |
|---|---|
| Former Name | JACK SHIELDS COUSINEAU |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT90191) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 90191) |
| Enumeration Date | 2010-10-08 |
| Last Update Date | 2025-02-05 |