Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 83349 | TX |
NPI | 1003434143 |
---|---|
Provider Name | Siduk Arroyo-Boulter |
First Address | Richardson, TX 75081-5579 |
Second Address | Richardson, TX 75081-5579 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2020 |
Last Update Date | 06/07/2020 |