Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | LA |
NPI | 1124313408 |
---|---|
Provider Name | Mrs. Gloria Allen |
First Address | Harvey, LA 70058-2454 |
Second Address | Harvey, LA 70058-2454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2011 |
Last Update Date | 14/06/2011 |