Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC009408 | PA |
NPI | 1003380312 |
---|---|
Provider Name | Tenera Styles |
First Address | Philadelphia, PA 19146-3506 |
Second Address | Philadelphia, PA 19143-5137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2019 |
Last Update Date | 20/01/2019 |