| NPI | 1629601604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 62615) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 104100000X Social Worker | |
| 1041S0200X Social Worker, School | |
| 171M00000X Case Manager/Care Coordinator | |
| 261QC1500X Clinic/Center, Community Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 251B00000X Case Management | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2024-06-27 |