| NPI | 1790115400 |
|---|---|
| Former Name | MELISSA KAY BANUELOS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 62123) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 62123) |
| 101YP2500X Counselor, Professional (Licence: TX 62123) | |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2019-10-16 |