Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | KLPPCO00210691 | KY |
NPI | 1356739205 |
---|---|
Provider Name | Dr. Frank James Stillwell |
First Address | Lexington, KY 40517-1960 |
Second Address | Lexington, KY 40508-2615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2014 |
Last Update Date | 30/12/2014 |