Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | TX |
NPI | 1326677782 |
---|---|
Provider Name | Jim Carel Ten Bosch |
First Address | Fremont, CA 94536-5460 |
Second Address | Fremont, CA 94536-5460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2020 |
Last Update Date | 07/04/2020 |