Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 79681 | TX |
NPI | 1003447236 |
---|---|
Provider Name | Nicole Leona Sallee |
First Address | Bedford, TX 76021-5120 |
Second Address | Fort Worth, TX 76102-3105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2020 |
Last Update Date | 27/01/2020 |