| NPI | 1952065849 |
|---|---|
| Former Name | JULIE MARIE BAZAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701010626) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: 19-186) |
| Enumeration Date | 2021-10-26 |
| Last Update Date | 2021-10-26 |