Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003200270 |
---|---|
Provider Name | Maria Goostree |
First Address | Bentonville, AR 72712-4576 |
Second Address | Bentonville, AR 72712-4576 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2015 |
Last Update Date | 25/03/2015 |