| NPI | 1609147131 |
|---|---|
| Former Name | INGRID RAINA LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2012-04-18 |