| NPI | 1619415254 |
|---|---|
| Former Name | MARY BLACKWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2026-07-31 |