Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | LH00004323 | WA |
NPI | 1043289846 |
---|---|
Provider Name | Paul F Shoup |
First Address | Camano Island, WA 98282 |
Second Address | Marysville, WA 98270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 08/07/2007 |