Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | AZ |
NPI | 1366947681 |
---|---|
Provider Name | Lisa Marie Smith |
First Address | Phoenix, AZ 85022-4371 |
Second Address | Phoenix, AZ 85022-4371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2018 |
Last Update Date | 28/03/2018 |