| NPI | 1679971337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS LCPC03725) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE P-1131) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY LAT-379) | |
| 101YM0800X Counselor, Mental Health (Licence: NE 3388) | |
| 101YM0800X Counselor, Mental Health (Licence: NE 10196) | |
| 101YM0800X Counselor, Mental Health (Licence: NE 5212) | |
| 101YP2500X Counselor, Professional (Licence: WY LPC-1748) | |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2024-07-03 |