| NPI | 1790064145 |
|---|---|
| Former Name | JESSICA E THEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC1805) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH8991) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2019-08-08 |