| NPI | 1912196569 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN 4716) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MN 4716) |
| 103TC1900X Psychologist Counseling (Licence: MN 4716) | |
| 103TE1100X Psychologist Exercise & Sports (Licence: MN 4716) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: MN 4716) | |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2014-06-18 |