Individual
JEREMY W DICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
323 E GRAND ST, SPRINGFIELD, MO 65807
(417) 761-5600
(417) 761-5601
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5011
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2015014046
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490021929
—
MO
Enumeration date
05/18/2015
Last updated
09/14/2020
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