Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor |
NPI | 1073184156 |
---|---|
Provider Name | Mrs. Tara Summer Trefzger-Blessent |
First Address | Bloomington, IL 61701-4741 |
Second Address | Bloomington, IL 61701-4741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2021 |
Last Update Date | 08/07/2021 |