| NPI | 1710012331 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: SC 723) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: SC 723) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: SC 723) | |
| 103T00000X Psychologist (Licence: SC 723) | |
| 106H00000X Marriage & Family Therapist (Licence: SC 723) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-08 |