Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 32049 | TX |
Y | 101YM0800X | Mental Health Counselor | 61409 | TX |
NPI | 1003183914 |
---|---|
Provider Name | Mr. Laramie C Selman |
First Address | Frankston, TX 75763-0883 |
Second Address | Tyler, TX 75701-6623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2011 |
Last Update Date | 20/11/2011 |