Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 76573 | TX |
NPI | 1003450438 |
---|---|
Provider Name | Mr. James Willie Hentz JR. |
First Address | Fort Worth, TX 76124-0095 |
Second Address | Kennedale, TX 76060-5602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2019 |
Last Update Date | 29/10/2019 |