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NPI Profile for LEROY JIM in GALLUP, NM.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X | |||
Rehabilitation Counselor |
225C00000X |
| NPI # | 1063627354 |
|
| Status | Active | |
| Credentials | LPCC, CRC | |
| Entity | Individual | |
| Enumeration date | 05/11/2007 | |
| Last updated | 06/15/2016 - About 10 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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LEROY JIM
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LEROY JIM, LPCC, CRC