Individual
MIRIAM SELAH BUTHELEZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFTA
Contact information
Practice address
120 W 7TH ST, BLOOMINGTON, IN 47404
(812) 269-6966
Mailing address
120 W 7TH ST, BLOOMINGTON, IN 47404-3834
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
99096527A
IN
Other
Enumeration date
02/05/2020
Last updated
02/05/2020
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