| NPI | 1659940039 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 82714) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 82714) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2022-09-21 |