| NPI | 1689963605 |
|---|---|
| Former Name | TARA MARIE KERSJES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401017225) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401012207) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2019-10-10 |