NPI | 1679649313 |
---|---|
Former Name | JOAN MARYLYN REYNOLDS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 15357) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 003689016822) |
Enumeration Date | 2006-11-27 |
Last Update Date | 2007-07-08 |