Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1295366250 |
---|---|
Provider Name | Victor C Victor |
First Address | Missouri City, TX 77459-5060 |
Second Address | Missouri City, TX 77459-5060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2020 |
Last Update Date | 29/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
76-06388-96 | IRS (01) | TX |