Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | LPC-2926 | ID |
NPI | 1003157025 |
---|---|
Provider Name | Monty D Hays |
First Address | Moscow, ID 83843-3128 |
Second Address | Moscow, ID 83843-3128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2013 |
Last Update Date | 15/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1356677765 | (05) | ID |