Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor |
NPI | 1336641190 |
---|---|
Provider Name | Keith Crowner |
First Address | Portland, OR 97203-1177 |
Second Address | Portland, OR 97203-1177 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2018 |
Last Update Date | 07/03/2018 |