| NPI | 1972874105 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MN CC00402) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MN CC00402) |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2014-12-09 |