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Individual
JONATHAN TAYLOR SHIELDS
Active
Individual
JONATHAN TAYLOR SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHA
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
101Y00000X
OR
372600000X
Adult Companion
Primary
—
NULL
Other
Enumeration date
06/01/2011
Last updated
02/23/2015
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