Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 44 | NH |
NPI | 1366500951 |
---|---|
Provider Name | Mr. Bayard Preston Herndon |
First Address | Manchester, NH 03104 |
Second Address | Manchester, NH 03104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3006287 | (05) | NH |