Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 3333 | TX |
NPI | 1013023563 |
---|---|
Provider Name | Joe B Luther |
First Address | Austin, TX 78750-7931 |
Second Address | Austin, TX 78741-6411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |