| NPI | 1720359102 |
|---|---|
| Former Name | KELLY DEAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MA 8491) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 8491) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2019-09-13 |