Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 74104 | TX |
NPI | 1003330986 |
---|---|
Provider Name | Manuel G Olvera |
First Address | Rosenberg, TX 77471-5759 |
Second Address | Bay City, TX 77414-4102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2017 |
Last Update Date | 01/08/2017 |