Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1093072811 |
---|---|
Provider Name | Michael Menafee |
First Address | Indianapolis, IN 46256-4649 |
Second Address | Indianapolis, IN 46250-2040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2012 |
Last Update Date | 18/04/2012 |