Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 12479 | TX |
NPI | 1134751647 |
---|---|
Provider Name | Kenneth A Brown SR. |
First Address | San Antonio, TX 78244-4431 |
Second Address | San Antonio, TX 78229-6114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2020 |
Last Update Date | 12/02/2020 |