| NPI | 1558776880 |
|---|---|
| Former Name | JENELLE PATRICIA GONZALEZ, BANASZAK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH21266) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH19534) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2022-09-19 |