| NPI | 1821135195 |
|---|---|
| Former Name | JEAN ELICK LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 14157) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: 97-040) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2019-07-24 |