| NPI | 1619074358 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 17503) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 17503) |
| 101YM0800X Counselor, Mental Health (Licence: AZ 17503) | |
| 103T00000X Psychologist (Licence: AZ 17503) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 17503) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: AZ 17503) | |
| 174400000X Specialist (Licence: AZ 17503) | |
| 207Q00000X Family Medicine (Licence: AZ 17503) | |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: AZ 17503) | |
| 251S00000X (Licence: AZ 17503) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: AZ 17503) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2023-06-20 |