NPI | 1659678647 |
---|---|
Former Name | TARA BETH POOL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 4097) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 0935) |
Enumeration Date | 2011-02-28 |
Last Update Date | 2012-04-03 |