Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 5456 | CO |
NPI | 1003128737 |
---|---|
Provider Name | Mr. James Michael Sheeran |
First Address | Crestone, CO 81131-0464 |
Second Address | Crestone, CO 81131-0464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2010 |
Last Update Date | 10/07/2010 |