| NPI | 1790123610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 32786) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 32786) |
| 101YP2500X Counselor, Professional (Licence: TX 32786) | |
| 101YS0200X Counselor, School (Licence: TX 32786) | |
| 1041S0200X Social Worker, School (Licence: TX 32786) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 32786) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2013-06-13 |