| NPI | 1942921671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 281220) |
| Additional Taxonomies | 251B00000X Case Management |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 251S00000X Community/Behavioral Health | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10018648) | |
| 106S00000X Behavior Technician | |
| 103TP0016X Psychologist, Prescribing (Medical) | |
| 103TP0814X Psychologist, Psychoanalysis | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1092621) | |
| 171M00000X Case Manager/Care Coordinator | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2022-09-09 |
| Last Update Date | 2025-11-10 |