| NPI | 1790042596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX 495743) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 495743) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2012-04-18 |