Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003261249 |
---|---|
Provider Name | Emily Champa |
First Address | Winnemucca, NV 89445-6090 |
Second Address | Winnemucca, NV 89445-6090 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2016 |
Last Update Date | 25/04/2016 |