Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 16657 | FL |
NPI | 1366953499 |
---|---|
Provider Name | Kris Reece |
First Address | Watchung, NJ 07069-6269 |
Second Address | Watchung, NJ 07069-6269 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2017 |
Last Update Date | 16/10/2017 |