| NPI | 1790869121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MN LP4004) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: MN LP4004) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-07-09 |