| NPI | 1629308259 |
|---|---|
| Former Name | JENNIFER MATLOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK LPC04799) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: HI MHC-607) |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2023-09-21 |