Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 581029 | MS |
NPI | 1073083945 |
---|---|
Provider Name | Daniel Locke Deason |
First Address | Oxford, MS 38655-7276 |
Second Address | University, MS 38677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2018 |
Last Update Date | 04/12/2018 |