| NPI | 1669724316 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR T0982) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist (Licence: CA 69067) | |
| 106H00000X Marriage & Family Therapist (Licence: OR T0982) | |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2024-07-30 |