| NPI | 1801998091 |
|---|---|
| Former Name | NELL SISTRUNK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 24074) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 24074) |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: TX 24074) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2022-07-21 |