NPI | 1720406028 |
---|---|
Former Name | DANIELLE BLUM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc00730) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN cc00730) |
103TC0700X Psychologist, Clinical (Licence: MN cc00730) | |
Enumeration Date | 2014-04-03 |
Last Update Date | 2023-12-06 |