| NPI | 1568848968 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP6645) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 2278-226) |
| 103TC0700X Psychologist, Clinical (Licence: CO PSY.0004345) | |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2021-04-06 |