Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003267881 |
---|---|
Provider Name | Haley Ruth Clemens |
First Address | Owosso, MI 48867-9775 |
Second Address | Owosso, MI 48867-9775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2016 |
Last Update Date | 11/12/2020 |