Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PY 00003427 | WA |
NPI | 1073696290 |
---|---|
Provider Name | John D. Hughes |
First Address | Walla Walla, WA 99362-2058 |
Second Address | Walla Walla, WA 99362-1925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |