Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1134423064 |
---|---|
Provider Name | Mr. John Christopher Traffanstedt |
First Address | Mustang, OK 73064-4234 |
Second Address | Mustang, OK 73064-4234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2011 |
Last Update Date | 12/07/2011 |