| NPI | 1659825511 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2019019263) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 767) |
| 101YP2500X Counselor, Professional (Licence: MO 20100007512) | |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2019-06-25 |