Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003314360 |
---|---|
Provider Name | Karen Wilfong |
First Address | Tomball, TX 77377-1600 |
Second Address | Houston, TX 77070-4462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2018 |
Last Update Date | 31/01/2018 |