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Individual
JEREMY W DICKSON
Active
Individual
JEREMY W DICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2015014046
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490021929
—
MO
Enumeration date
05/18/2015
Last updated
09/14/2020
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