Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY 01925 | MO |
N | 103TA0700X | Adult Development & Aging Psychologist | ||
Y | 103G00000X | Clinical Psychologist | PY 01925 | MO |
Y | 103TC0700X | Clinical Psychologist | PY 01925 | MO |
NPI | 1548241144 |
---|---|
Provider Name | Dr. Carol Sue Dyer |
First Address | Saint Louis, MO 63117-1328 |
Second Address | Saint Louis, MO 63117-1328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 29/04/2010 |