Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1356878557 |
---|---|
Provider Name | William Hennessy |
First Address | Jonesville, MI 49250-1136 |
Second Address | Jonesville, MI 49250-1136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2017 |
Last Update Date | 18/05/2017 |