Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LH60067868 | WA |
NPI | 1003065053 |
---|---|
Provider Name | Mr. Keith Poynter |
First Address | Bellingham, WA 98226-9278 |
Second Address | Bellingham, WA 98226-9278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2008 |
Last Update Date | 05/11/2010 |