Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 127375 | KY |
NPI | 1144774639 |
---|---|
Provider Name | Mr. Glenn D Williams |
First Address | Louisville, KY 40223-4046 |
Second Address | Louisville, KY 40223-4046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2016 |
Last Update Date | 12/08/2016 |