| NPI | 1720506595 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 99612) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2025-09-05 |