| NPI | 1962755660 |
|---|---|
| Former Name | KRISYN ROUSE FUNKHOUSER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL 3323) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL C2041A) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2019-01-23 |