NPI | 1629447487 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: KY 800396) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY LPCCCA00223149) |
101YM0800X Counselor, Mental Health (Licence: KY 246422) | |
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 | 2025-02-25 |