Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1013211234 |
---|---|
Provider Name | Mr. Anthony Phillips |
First Address | Albuquerque, NM 87109 |
Second Address | Albuquerque, NM 87102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2011 |
Last Update Date | 03/01/2011 |