| NPI | 1639632698 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61187444) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WA CB60918710) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2021-07-20 |