| NPI | 1972269926 |
|---|---|
| Former Name | AMBER ELIZABETH MANGUS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 15351) |
| Enumeration Date | 2021-11-15 |
| Last Update Date | 2021-11-18 |