| NPI | 1952016099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 76283) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 76283) |
| 101YP2500X Counselor, Professional (Licence: TX 76283) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 76283) | |
| 101Y00000X Counselor (Licence: TX 76283) | |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2025-09-19 |