Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1194943530 |
---|---|
Provider Name | Mr. Joseph Lee Anthony |
First Address | Kerrville, TX 78029 |
Second Address | Kerrville, TX 78028-5768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |