NPI | 1669881348 |
---|---|
Former Name | LISA KRISTINE TANKERSLEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60628904) |
Additional Taxonomies | 103T00000X Psychologist (Licence: KS 2538) |
Enumeration Date | 2014-08-07 |
Last Update Date | 2018-10-17 |