| NPI | 1912112335 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 34175) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA 34175) |
| 101YM0800X Counselor Mental Health (Licence: NE 8162) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA WAIVER) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2024-02-25 |