Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1366196842 |
---|---|
Provider Name | Melanese Stitts |
First Address | Montgomery, IL 60538-4063 |
Second Address | Montgomery, IL 60538-4063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2022 |
Last Update Date | 04/02/2022 |