Individual
IDA PIPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
642 E WOODLAND ST, REPUBLIC, MO 65738-1140
(417) 425-5193
Mailing address
642 E WOODLAND ST, REPUBLIC, MO 65738-1140
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2016013440
MO
Other
Enumeration date
05/13/2016
Last updated
05/13/2016
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