| NPI | 1982288361 |
|---|---|
| Former Name | AMANDA RUNYAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2020029276) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KS LCPC03431) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2023-05-09 |