Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1205589686 |
---|---|
Provider Name | Joseph Mathai Olikkara |
First Address | Bay Pines, FL 33744-8200 |
Second Address | Bay Pines, FL 33744-8200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2022 |
Last Update Date | 27/01/2022 |