| NPI | 1588739072 |
|---|---|
| Former Name | TRACY MARIE SEVERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 48991) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2023-12-14 |