Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1295094514 |
---|---|
Provider Name | Toi Annette Ethridge |
First Address | North Las Vegas, NV 89031-7917 |
Second Address | North Las Vegas, NV 89031-7917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2012 |
Last Update Date | 07/05/2012 |