| NPI | 1861018863 |
|---|---|
| Former Name | MARDY ELLIS JUHL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15486) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15743) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2020-06-25 |