NPI | 1669141594 |
---|---|
Former Name | NATALIE LAUREN MATHENY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008182) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 11687-PY-PR) |
Enumeration Date | 2021-09-13 |
Last Update Date | 2024-06-04 |