| NPI | 1619479136 |
|---|---|
| Former Name | TIFFANY NOWELL PELLETIER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 2085) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0004571) |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2018-04-18 |