| NPI | 1811649163 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2025-0071) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NM CCMH0214871) |
| 101YM0800X Counselor, Mental Health (Licence: NM CCMH0214871) | |
| Enumeration Date | 2022-01-18 |
| Last Update Date | 2025-09-02 |