Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor |
NPI | 1376012740 |
---|---|
Provider Name | Mr. Gregory Roy Smith SR. |
First Address | Apo, AE 09114-0053 |
Second Address | Velburg, BAVARIA 92355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2018 |
Last Update Date | 15/11/2018 |