| NPI | 1629447487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 246422) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY LPCCCA00223149) |
| 101YP2500X Counselor, Professional (Licence: KY LPCCCA00223149) | |
| 101YP2500X Counselor, Professional (Licence: KY 246422) | |
| 171M00000X Case Manager/Care Coordinator (Licence: KY 0331) | |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2019-01-19 |