| NPI | 1700149879 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY PSYLIP00211362) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 4334) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 4334) | |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2021-01-21 |