Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 75397 | TX |
Y | 101YP2500X | Professional Counselor | 75397 | TX |
NPI | 1003215443 |
---|---|
Provider Name | Ms. Michele Jones Dial |
First Address | Houston, TX 77040-2524 |
Second Address | Houston, TX 77007-3387 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2014 |
Last Update Date | 26/11/2018 |