| NPI | 1972637445 |
|---|---|
| Former Name | KELLIE MACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC 47389) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LMFT 4401) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2013-11-08 |