| NPI | 1679121263 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MN CC02161) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: MN R78605-2) |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2019-08-28 |