Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1053988006 |
---|---|
Provider Name | Jay Williams |
First Address | Albuquerque, NM 87102 |
Second Address | Burleson, TX 76028-2797 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2021 |
Last Update Date | 08/06/2021 |