Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 6401018236 | MI |
N | 101YS0200X | School Counselor | SC0000000913456 | MI |
NPI | 1215566757 |
---|---|
Provider Name | Ezekiel Moreno |
First Address | Lansing, MI 48917-2035 |
Second Address | Lansing, MI 48917-2035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2020 |
Last Update Date | 21/05/2020 |