Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC-779 | WY |
NPI | 1003164955 |
---|---|
Provider Name | Starr Marie Sonne |
First Address | Jackson, WY 83001-1503 |
Second Address | Jackson, WY 83001-8494 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2012 |
Last Update Date | 30/04/2013 |