Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | CA |
NPI | 1194316695 |
---|---|
Provider Name | Mr. Michael George |
First Address | Shafter, CA 93263-9443 |
Second Address | Bakersfield, CA 93308-6337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2021 |
Last Update Date | 28/01/2021 |