| NPI | 1770924961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 68344) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 68344) |
| 101YP2500X Counselor, Professional (Licence: TX 68344) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 68344) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 68344) | |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2025-11-26 |