Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1003572363 |
---|---|
Provider Name | Thomas W Graves |
First Address | Franklinton, LA 70438-5613 |
Second Address | Franklinton, LA 70438-5613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2021 |
Last Update Date | 11/11/2021 |