Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor |
NPI | 1366591497 |
---|---|
Provider Name | Dr. John Strange |
First Address | San Antonio, TX 78212 |
Second Address | San Antonio, TX 78212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 12/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104562 | VALUES OPTIONS PROVIDER N (01) | TX |
1407710-01 | (05) | TX |
4828 44622 | MFT LICENSURE TEXAS (01) | TX |