Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1255874483 |
---|---|
Provider Name | Jai Flicker |
First Address | Mill Valley, CA 94941-1183 |
Second Address | Mill Valley, CA 94941-5815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2016 |
Last Update Date | 20/11/2016 |