Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor |
NPI | 1205166600 |
---|---|
Provider Name | Mr. Kenneth Allen Burr |
First Address | Seattle, WA 98103-9051 |
Second Address | Seattle, WA 98103-9051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2010 |
Last Update Date | 06/01/2010 |