Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | 0035 | KY |
NPI | 1124244280 |
---|---|
Provider Name | Joe Bob Pierce JR. |
First Address | Owensboro, KY 42301-4985 |
Second Address | Owensboro, KY 42303-3437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 28/06/2011 |