| NPI | 1831866904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: TX 86763) |
| 101YP2500X Counselor, Professional (Licence: TX 86763) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health (Licence: TX 86763) | |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2026-02-25 |