Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | RC00058439 | WA |
NPI | 1003097361 |
---|---|
Provider Name | Mr. James Wesley Pogue JR. |
First Address | Federal Way, WA 98003-6608 |
Second Address | Tacoma, WA 98405-4851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2007 |
Last Update Date | 15/11/2007 |