Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 7214350 | TN |
NPI | 1134405095 |
---|---|
Provider Name | Mrs. Laura Chustek |
First Address | Clarksville, TN 37042 |
Second Address | Clarksville, TN 37043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2011 |
Last Update Date | 24/10/2011 |