Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 20069 | TX |
NPI | 1003092404 |
---|---|
Provider Name | Ms. Ellen Lynn Santolucito |
First Address | Killeen, TX 76541-9166 |
Second Address | Killeen, TX 76541-9166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2008 |
Last Update Date | 15/01/2008 |