Individual
LEON VANDYKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 W MORRISON ST STE 16, FAYETTE, MO 65248-1075
(775) 997-8646
Mailing address
600 W MORRISON ST STE 16, FAYETTE, MO 65248-1075
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2024036077
MO
Other
Enumeration date
09/05/2024
Last updated
09/05/2024
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