Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ZZ | |
Y | 101YP1600X | Pastoral Counselor | 18402 | KY |
NPI | 1326574278 |
---|---|
Provider Name | William Gammon |
First Address | Owensboro, KY 42302-0322 |
Second Address | Owensboro, KY 42301-3076 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 08/12/2018 |