Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1053662387 |
---|---|
Provider Name | Scott C Stanton |
First Address | Wasilla, AK 99654-8512 |
Second Address | Wasilla, AK 99654-8512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2012 |
Last Update Date | 26/09/2012 |