Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1043449804 |
---|---|
Provider Name | Miss Trent Leighton |
First Address | Kotzebue, AK 99752-0256 |
Second Address | Kotzebue, AK 99752-0256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2009 |
Last Update Date | 14/07/2009 |