| NPI | 1619351483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCSW-LIC-55520) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 7753052-3501) |
| 1041C0700X Social Worker, Clinical (Licence: ID LCSW-37858) | |
| 101YM0800X Counselor, Mental Health (Licence: WY LCSW-1630) | |
| Enumeration Date | 2015-07-11 |
| Last Update Date | 2025-08-26 |