| NPI | 1942718028 |
|---|---|
| Former Name | KELLY JEAN MOUSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CC01721) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MN CC01721) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2023-12-15 |