Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 09235008 | MO |
NPI | 1033562111 |
---|---|
Provider Name | Carol Rice |
First Address | Jefferson City, MO 65109-2178 |
Second Address | Jefferson City, MO 65109-2178 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2016 |
Last Update Date | 13/07/2016 |