Individual
DR. JERRELL LEE DRIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2387 W JACKSON BLVD, SUITE B, JACKSON, MO 63755-3024
(573) 204-7771
(573) 204-7771
Mailing address
POST OFFICE BOX 1642, CAPE GIRARDEAU, MO 63702-1642
(573) 204-7771
(573) 204-7771
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY 00099
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
493204309
—
MO
01
—
PY00099
MO-LICENSE PSYCHOLOGIST
—
Enumeration date
08/02/2005
Last updated
09/10/2011
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