| NPI | 1952004913 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 83938) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 83938) |
| 101YM0800X Counselor, Mental Health (Licence: TX 83938) | |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2023-12-22 |