Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | LA |
NPI | 1356879324 |
---|---|
Provider Name | Angel R Cosme |
First Address | Kenner, LA 70065-2190 |
Second Address | Kenner, LA 70065-2190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2017 |
Last Update Date | 02/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111 | CERTIFIED HYPNOTHERAPIST (01) | LA |