| NPI | 1639416951 |
|---|---|
| Former Name | JESSICA ENRIQUEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: WA 261QM0801X) |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2013-01-07 |