Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 2015040214 | MO |
Y | 101YP2500X | Professional Counselor | 2015040214 | MO |
NPI | 1003335613 |
---|---|
Provider Name | Amanda S Yochum |
First Address | Arnold, MO 63010-1012 |
Second Address | Festus, MO 63028-1816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2017 |
Last Update Date | 13/07/2021 |