| NPI | 1730731316 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MN CC02197) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MN 2197) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2021-11-08 |