| NPI | 1639675184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AZ LPC16741) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LPC16741) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: AZ LPC167741) | |
| 101YP2500X Counselor Professional (Licence: AZ LPC16741) | |
| 106H00000X Marriage & Family Therapist (Licence: AZ LPC16741) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2018-04-03 |