| NPI | 1750989802 |
|---|---|
| Former Name | ILLYSSA ANN SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2303571) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C1902131-TRNE) |
| 101YM0800X Counselor, Mental Health (Licence: OH C2103326) | |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2023-07-21 |