NPI | 1750909594 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: LA 1729) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 12959) |
106S00000X Behavior Technician (Licence: MS 20-125500) | |
Enumeration Date | 2020-07-08 |
Last Update Date | 2024-09-27 |