Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LPC-12141 | AZ |
N | 101YM0800X | Mental Health Counselor | LPC-12141 | AZ |
NPI | 1003230921 |
---|---|
Provider Name | Mr. Gary Hees |
First Address | Prescott, AZ 86301-1747 |
Second Address | Prescott, AZ 86301-1747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2014 |
Last Update Date | 12/02/2014 |