Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003000878 |
---|---|
Provider Name | Mrs. Ellen Veenstra |
First Address | Burbank, CA 91502-1463 |
Second Address | Glendale, CA 91205-1514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 05/09/2007 |