NPI | 1891977427 |
---|---|
Former Name | JESSICA FAYE LENZ |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD LPC-MH 2217) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SD LPC1190) |
Enumeration Date | 2007-12-05 |
Last Update Date | 2012-09-21 |