| NPI | 1629886833 |
|---|---|
| Former Name | MCKENZIE NICOLE POULSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-PCLC-LIC-69819) |
| Enumeration Date | 2024-12-19 |
| Last Update Date | 2024-12-19 |