| NPI | 1629793138 |
|---|---|
| Former Name | JEREMY MAVIN OATS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2022-10-06 |
| Last Update Date | 2022-10-06 |