Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1295168706 |
---|---|
Provider Name | Leron Gregory West |
First Address | Tulsa, OK 74149-0762 |
Second Address | Tulsa, OK 74127-2506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2013 |
Last Update Date | 20/08/2013 |