Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor |
NPI | 1003224338 |
---|---|
Provider Name | Jean-Mary Monval |
First Address | Port St Lucie, FL 34953-2845 |
Second Address | Fort Pierce, FL 34947-4795 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2014 |
Last Update Date | 04/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020753600 | (05) | FL |