| NPI | 1902178510 |
|---|---|
| Former Name | JESSICA LYNN BALSAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 1221) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2016-11-11 |