Individual
DR. MICAH OSBORNE MAZUREK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
205 PORTLAND ST, COLUMBIA, MO 65201-6521
(573) 884-8502
(573) 884-6421
Mailing address
PO BOX 7687, COLUMBIA, MO 65205-7687
(573) 882-2259
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2006016143
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11616561
CAQH PROVIDER ID
MO
Enumeration date
01/18/2007
Last updated
10/28/2010
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