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Individual
MS. PETRA GERARDA DE GROOT
Active
Individual
MS. PETRA GERARDA DE GROOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MT 441
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74933
BLUE CROSS & BLUE SHIELD
MT
Enumeration date
05/08/2007
Last updated
07/08/2007
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