| NPI | 1760420020 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KY 1444) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: KY 1444) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: KY 1444) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: OH 6434) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: OH 6434) | |
| 103TC0700X Psychologist Clinical (Licence: OH 6434) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2015-08-11 |