| NPI | 1780071365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 9166634-1206) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 9166634-6008) |
| 101YM0800X Counselor, Mental Health (Licence: UT 9166634-6004) | |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2024-03-04 |