Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YP1600X | Pastoral Counselor |
NPI | 1174918502 |
---|---|
Provider Name | Janet Malone |
First Address | Memphis, TN 38104 |
Second Address | Memphis, TN 38104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2015 |
Last Update Date | 02/04/2015 |