Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 71893 | TX |
NPI | 1003264037 |
---|---|
Provider Name | Ms. Anna Chance |
First Address | Mission, TX 78574-2349 |
Second Address | Mission, TX 78574-2349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2016 |
Last Update Date | 31/05/2016 |