Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ICAADC 159 | TX |
N | 101YP1600X | Pastoral Counselor | NONE | |
Y | 101YP2500X | Professional Counselor | 7220 | TX |
NPI | 1346323706 |
---|---|
Provider Name | Mr. Billy Winford Corn |
First Address | Kemp, TX 75143-4354 |
Second Address | Kemp, TX 75143-4354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2006 |
Last Update Date | 17/04/2020 |