Individual
SHAUN FOSSETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1310 E KINGSLEY ST, SUITE C, SPRINGFIELD, MO 65804-7254
(417) 822-7700
Mailing address
700 S WELLER AVE, SPRINGFIELD, MO 65802-3345
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2015043556
MO
Other
Enumeration date
06/06/2016
Last updated
06/06/2016
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