| NPI | 1942417696 |
|---|---|
| Former Name | MICHELLE DERESCHUK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 3096) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT0324) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2009-02-13 |