| NPI | 1619650744 |
|---|---|
| Former Name | JILL VAN OTTERLOO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 3974) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305949) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-08-07 |