| NPI | 1639125792 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 2729-125) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP3112) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2009-02-26 |