Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 82277 | TX |
NPI | 1003560483 |
---|---|
Provider Name | Kindra Renee Marietti |
First Address | San Antonio, TX 78248-4552 |
Second Address | San Antonio, TX 78248-4552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2022 |
Last Update Date | 04/02/2022 |