Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1134605827 |
---|---|
Provider Name | Mr. George Henry Brenard |
First Address | Loleta, CA 95551-9627 |
Second Address | Loleta, CA 95551-9627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2018 |
Last Update Date | 16/07/2018 |