| NPI | 1720222128 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY 477) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY LPC-477A) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2012-05-24 |