| NPI | 1891912051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO 2199) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CO 2199) |
| 101YP1600X Counselor Pastoral (Licence: CO 2199) | |
| 103T00000X Psychologist (Licence: CO 2199) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: CO 2199) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CO 2199) | |
| 103TC0700X Psychologist Clinical (Licence: CO 2199) | |
| 103TC1900X Psychologist Counseling (Licence: CO 2199) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CO 2199) | |
| 103TE1100X Psychologist Exercise & Sports (Licence: CO 2199) | |
| 103TF0000X Psychologist Family (Licence: CO 2199) | |
| 103TH0004X Psychologist Health (Licence: CO 2199) | |
| 103TP0814X Psychologist Psychoanalysis (Licence: CO 2199) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CO 2199) | |
| 106H00000X Marriage & Family Therapist (Licence: CO 2199) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2007-07-08 |