Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 101YP1600X | KS |
NPI | 1003230723 |
---|---|
Provider Name | Sam Mason |
First Address | Paola, KS 66071-1304 |
Second Address | Paola, KS 66071-1304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2014 |
Last Update Date | 17/02/2014 |