| NPI | 1750762852 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 37113) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: VA 0810005220) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2021-06-07 |