Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1235348434 |
---|---|
Provider Name | Mr. Thomas Mcmillen Long |
First Address | Denver, CO 80222-4516 |
Second Address | Denver, CO 80222-4516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |