| NPI | 1720502685 |
|---|---|
| Former Name | KELLY TRUESDALE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6362008020) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: 6301017132) |
| 103T00000X Psychologist (Licence: MI 6301017132) | |
| 103T00000X Psychologist (Licence: 6362008020) | |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2020-06-15 |