NPI | 1912053174 |
---|---|
Former Name | KRISTEN SARAH MCCLELLAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301012278) |
Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MN CC00084) |
Enumeration Date | 2007-01-28 |
Last Update Date | 2018-07-12 |