| NPI | 1821631946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 68294) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11518) |
| 106H00000X Marriage & Family Therapist (Licence: TX 201731) | |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2024-10-21 |