Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 62206 | TX |
NPI | 1003163908 |
---|---|
Provider Name | Denise Rau |
First Address | League City, TX 77573-2943 |
Second Address | League City, TX 77573-2943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2012 |
Last Update Date | 10/08/2012 |