Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 79184 | TX |
Y | 101YM0800X | Mental Health Counselor | 79184 | TX |
N | 101YP1600X | Pastoral Counselor | 79184 | TX |
N | 101YP2500X | Professional Counselor | 79184 | TX |
NPI | 1235779182 |
---|---|
Provider Name | James Jordan Greenwald |
First Address | Dallas, TX 75231-7217 |
Second Address | Dallas, TX 75231-7217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2020 |
Last Update Date | 08/01/2020 |