NPI | 1811252430 |
---|---|
Former Name | TARA MCCORMICK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0170481) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0170481) |
101YM0800X Counselor, Mental Health (Licence: WA MC60292704) | |
Enumeration Date | 2012-07-10 |
Last Update Date | 2021-07-22 |