| NPI | 1639861974 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 39614) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| 103TS0200X Psychologist School | |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2025-06-27 |