Individual
MRS. MIRIAM AYALA SECO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA PSYCHOLOGY
Contact information
Practice address
614 SOUTH AVE, SPRINGFIELD, MO 65806-3110
(417) 869-9011
Mailing address
939 N PROSPECT AVE, SPRINGFIELD, MO 65802-3540
(417) 355-1642
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2016035423
MO
Other
Enumeration date
02/14/2018
Last updated
02/14/2018
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