| NPI | 1639894306 |
|---|---|
| Former Name | JEFFREY DOUGLAS SKAGGS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 105158) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 15589) |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2024-08-03 |