Individual
CLINT THEBEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1276 W LIBERTY ST, FARMINGTON, MO 63640
(573) 664-1722
Mailing address
1276 W LIBERTY ST, FARMINGTON, MO 63640-1990
(573) 664-1722
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
MO
Other
Enumeration date
07/24/2018
Last updated
07/24/2018
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