| NPI | 1699081125 |
|---|---|
| Other Name | KELLY EWALT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT 683) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT 683) |
| Enumeration Date | 2010-08-22 |
| Last Update Date | 2024-03-10 |