Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 51597 | CA |
NPI | 1174163968 |
---|---|
Provider Name | Dr. Mark Seelig |
First Address | Kelseyville, CA 95451-9757 |
Second Address | Kelseyville, CA 95451-9757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2020 |
Last Update Date | 09/01/2020 |