Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 65441 | TX |
N | 101YP2500X | Professional Counselor | 65441 | TX |
NPI | 1003124801 |
---|---|
Provider Name | Trina K Bluford Ita |
First Address | Austin, TX 78726-4224 |
Second Address | Austin, TX 78702-4206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2010 |
Last Update Date | 15/09/2010 |