| NPI | 1871794891 |
|---|---|
| Former Name | TRACIE MICHELLE CHURCHWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60724718) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA OT00003125) |
| 225XM0800X Occupational Therapist, Mental Health (Licence: WA OT 00003125) | |
| 225X00000X Occupational Therapist (Licence: WA OT 00003125) | |
| 101YM0800X Counselor, Mental Health (Licence: WA MC 60556138) | |
| 106H00000X Marriage & Family Therapist (Licence: WA MG 60565629) | |
| 101Y00000X Counselor (Licence: WA MC 60556138) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2017-01-11 |