Individual
JACOB FANTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PLP
Contact information
Practice address
1701 N CENTRAL AVE, MONETT, MO 65708-9999
(417) 476-1000
(417) 476-1082
Mailing address
PO BOX 100, PIERCE CITY, MO 65723-2100
(417) 476-1013
(417) 476-1082
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2022038992
MO
Other
Enumeration date
10/04/2022
Last updated
10/04/2022
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