| NPI | 1548631500 |
|---|---|
| Former Name | TANISHA MEDINA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60784954) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA MC60520063) |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2019-01-30 |