| NPI | 1770082885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: TX 76033) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 76033) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 76033) | |
| 101YM0800X Counselor Mental Health (Licence: TX 76033) | |
| 101YP2500X Counselor Professional (Licence: TX 76033) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: TX 76033) | |
| 103TR0400X Psychologist Rehabilitation (Licence: TX 76033) | |
| 251S00000X Community/Behavioral Health (Licence: TX 76033) | |
| Enumeration Date | 2018-02-04 |
| Last Update Date | 2018-02-04 |