Individual
DR. JERRELL LEE DRIVER
Active
Individual
DR. JERRELL LEE DRIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
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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