NPI | 1588074827 |
---|---|
Former Name | KELLEY LAVERNE LUTER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.011629) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
101YM0800X Counselor, Mental Health (Licence: IL 180011629) | |
Enumeration Date | 2014-05-07 |
Last Update Date | 2023-07-15 |