| NPI | 1710969936 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 10067) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 004444) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2007-07-08 |