Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1336496876 |
---|---|
Provider Name | Kristi Marie Mumford |
First Address | North Las Vegas, NV 89032-2508 |
Second Address | North Las Vegas, NV 89032-2508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2012 |
Last Update Date | 31/12/2013 |