| NPI | 1649852906 |
|---|---|
| Former Name | ELIZABETH WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MG61524353) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2024-07-11 |