Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2017014930 | MO |
NPI | 1003460007 |
---|---|
Provider Name | Cowartiz Merkerson |
First Address | Belton, MO 64012-7855 |
Second Address | Kansas City, MO 64114-5806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2019 |
Last Update Date | 29/07/2019 |