Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | PT 22741 | CA |
NPI | 1003027996 |
---|---|
Provider Name | Mr. Jeff Michael Lloyd |
First Address | San Luis Obispo, CA 93406-3641 |
Second Address | San Luis Obispo, CA 93401-6766 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 08/07/2007 |