| NPI | 1841255684 |
|---|---|
| Former Name | AMANDA NELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9351) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2006031373) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2023-08-15 |