| NPI | 1609527662 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP6750) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist (Licence: MN LP6750) | |
| 103TF0200X Psychologist, Forensic (Licence: MN LP6750) | |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2022-01-11 |