| NPI | 1881075562 |
|---|---|
| Former Name | BLANCA IRASEMA TELLEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: HI BA-823-0) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2023-11-03 |