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Contact Information

STATE OF MISSOURI
1706 E ELM ST
JEFFERSON CITY, MO65101-4130
 Phone: 573-751-3398
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Rehabilitation

103TR0400X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for STATE OF MISSOURI · (Female)

NPI Number 1578199238
Status Active
Credentials
Entity Individual
Enumeration date 03/13/2020
Last updated 10/27/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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