| NPI | 1619202520 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: LA LPC #1580; LMFT #88) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WA LMHC #60032033) |
| Enumeration Date | 2009-10-09 |
| Last Update Date | 2009-10-09 |