| NPI | 1558971895 |
|---|---|
| Former Name | TERRY JEAN BRODKORB |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-08-02 |
| Last Update Date | 2024-07-24 |