Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1174040703 |
---|---|
Provider Name | Kareem Jackson |
First Address | Houston, TX 77051-2801 |
Second Address | Houston, TX 77051-2801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2017 |
Last Update Date | 24/08/2017 |