Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1326695578 |
---|---|
Provider Name | Sherman Woody |
First Address | Shiprock, NM 87420-1830 |
Second Address | Shiprock, NM 87420-1830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2019 |
Last Update Date | 22/08/2019 |