Individual
JACQUELIN NICKOLE PSOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCP
Contact information
Practice address
614 MERCHANT ST, EMPORIA, KS 66801-2859
(620) 794-8616
Mailing address
2001 MEADOWLARK LN, EMPORIA, KS 66801-6127
(620) 794-8616
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1495
KS
103TC0700X
Clinical Psychologist
Primary
926
KS
Other
Enumeration date
01/10/2007
Last updated
02/04/2021
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