Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1164083507 |
---|---|
Provider Name | Mr. Matthew Ray |
First Address | Leland, MS 38756-2903 |
Second Address | Leland, MS 38756-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2019 |
Last Update Date | 26/06/2019 |