Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1336535012 |
---|---|
Provider Name | James Michaud |
First Address | Coon Rapids, MN 55433-2917 |
Second Address | St. Paul, MN 55104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2015 |
Last Update Date | 09/04/2015 |