Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1336661305 |
---|---|
Provider Name | Raymond Nelson |
First Address | Baton Rouge, LA 70815-5605 |
Second Address | Baton Rouge, LA 70815-5605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2017 |
Last Update Date | 12/07/2017 |