| NPI | 1750491007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 19107) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 5729) |
| 101YM0800X Counselor Mental Health (Licence: TX 19107) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 101YP2500X Counselor Professional | |
| 101Y00000X Counselor | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2017-02-17 |