Individual
Inactive
Sole proprietor
Provider details
NPI number
Contact information
Taxonomy
Speciality
Code
Description
License number
State
103TF0200X
Forensic Psychologist
Primary
LC0741199
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000159802
MO LIC PSYCHOLOGIST
MO
Enumeration date
—
Last updated
—
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