Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401013438 | MI |
NPI | 1003173782 |
---|---|
Provider Name | Kathleen Mousseau |
First Address | Saint Clair Shores, MI 48081-2323 |
Second Address | Saint Clair Shores, MI 48081-2323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2012 |
Last Update Date | 06/04/2017 |