Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor |
NPI | 1255716676 |
---|---|
Provider Name | Dr. Marcus Contrell Hart |
First Address | West Allis, WI 53227-2029 |
Second Address | West Allis, WI 53227-2029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2015 |
Last Update Date | 27/07/2015 |