Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YP1600X | Pastoral Counselor | 26-0-086-469 | CA |
NPI | 1083090609 |
---|---|
Provider Name | Phillip Washington SR. |
First Address | Las Vegas, NV 89115-0770 |
Second Address | Las Vegas, NV 89115-0770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2015 |
Last Update Date | 05/08/2015 |