Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC1900X | Counseling Psychologist | PY01161 | MO |
N | 103TH0100X | Health Service | PY01161 | MO |
NPI | 1114976941 |
---|---|
Provider Name | Carole Bernard |
First Address | Columbia, MO 65201-5275 |
Second Address | Columbia, MO 65201-5275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 08/07/2007 |