| NPI | 1881248516 |
|---|---|
| Former Name | SHANNON CHRISTOPHER COURSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NE 1132) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 699) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2023-10-16 |