Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | NY | |
N | 101YP1600X | Pastoral Counselor | NY |
NPI | 1225668270 |
---|---|
Provider Name | Edward Todd Harris III |
First Address | Buffalo, NY 14217-1165 |
Second Address | Buffalo, NY 14217-1165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2020 |
Last Update Date | 17/01/2020 |