| NPI | 1841400140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IN 39000601A) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: PA NA) |
| 1041C0700X Social Worker Clinical (Licence: IN 34002526A) | |
| 106H00000X Marriage & Family Therapist (Licence: IN 35000229A) | |
| 106H00000X Marriage & Family Therapist (Licence: KY 0126) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2011-01-03 |