Individual
DUSTAN YATES CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 W ASHLAND ST, NEVADA, MO 64772-1710
(314) 712-3411
Mailing address
128 S CLAY ST, NEVADA, MO 64772-3132
(314) 712-3411
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2020040530
MO
Other
Enumeration date
01/08/2021
Last updated
01/08/2021
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