Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YM0800X | Mental Health Counselor | 2010030535 | MO |
NPI | 1003136680 |
---|---|
Provider Name | Alicia Mclemore |
First Address | Lees Summit, MO 64086-5544 |
Second Address | Lees Summit, MO 64086-5544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2010 |
Last Update Date | 17/03/2018 |