| NPI | 1659721371 |
|---|---|
| Former Name | CARISSA MARIE GUTSMIEDL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC.0018023) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 7938-125) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2022-02-15 |