Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 71526 | TX |
NPI | 1003275256 |
---|---|
Provider Name | Kathleen Fitzsimmons |
First Address | San Antonio, TX 78248-1677 |
Second Address | Fair Oaks Ranch, TX 78006-9105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2016 |
Last Update Date | 16/02/2016 |