Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | LCMFT0241021200 | FL |
NPI | 1346371077 |
---|---|
Provider Name | Paul Evans |
First Address | Melbourne, FL 32934-7213 |
Second Address | Melbourne, FL 32934-7213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 15/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
076542200 | (05) | FL |
768243300 | (05) | FL |