Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1225319221 |
---|---|
Provider Name | Courtney Lee Gwin |
First Address | Paradise, CA 95969-3280 |
Second Address | Paradise, CA 95969-3280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2011 |
Last Update Date | 05/09/2012 |