Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003128158 |
---|---|
Provider Name | Mrs. Emily Dianne Head |
First Address | Hickory Creek, TX 75065-7646 |
Second Address | Hickory Creek, TX 75065-7646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 27/08/2012 |