| NPI | 1952629131 |
|---|---|
| Former Name | MIRANDA ELLEN KOEPKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3892) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 9088) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE P-877) | |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2011-09-09 |