Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor |
NPI | 1003126558 |
---|---|
Provider Name | Mr. Taurell Reboulet |
First Address | Woodinville, WA 98072-9737 |
Second Address | Woodinville, WA 98072-9737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2010 |
Last Update Date | 09/05/2013 |