| NPI | 1952705428 |
|---|---|
| Former Name | MELISSA KAREN MAYBERRY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0198061) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2018-08-17 |