Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 84778 | TX |
NPI | 1003409186 |
---|---|
Provider Name | Elise Dauksza |
First Address | Conroe, TX 77304-1403 |
Second Address | Conroe, TX 77304-1403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2021 |
Last Update Date | 18/02/2021 |