Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 68616 | TX |
Y | 101YP2500X | Professional Counselor | 68016 | TX |
NPI | 1003238726 |
---|---|
Provider Name | Mr. Rios Waddleton |
First Address | Midland, TX 79701-3944 |
Second Address | Midland, TX 79701-3944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2014 |
Last Update Date | 15/01/2014 |