Individual
GARY BRETT JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PLPC
Contact information
Practice address
1111 S GLENSTONE AVE, SPRINGFIELD, MO 65804-0313
(417) 761-5800
Mailing address
2885 W BATTLEFIELD ST, SPRINGFIELD, MO 65807-3952
(417) 761-5214
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2024034538
MO
Other
Enumeration date
05/02/2024
Last updated
08/27/2024
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