Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 1041C0700X | Clinical Social Worker | 10888 | TX |
NPI | 1326338807 |
---|---|
Provider Name | Richard William Lawrence |
First Address | Tyler, TX 75703-1629 |
Second Address | Tyler, TX 75703-1629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2011 |
Last Update Date | 26/04/2011 |