| 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 |