| NPI | 1649340084 |
|---|---|
| Former Name | MARY ANN FAHLSTROM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0724) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 47696) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2015-06-30 |