| NPI | 1720552086 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61635283) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: WA MC61351303) | |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2025-02-11 |