| NPI | 1891946554 |
|---|---|
| Former Name | JENNY LYNN MOULTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401016220) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH5541) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2021-12-30 |