Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PY01689 | MO |
NPI | 1104933746 |
---|---|
Provider Name | Dr. Christopher John Maglio |
First Address | Kirksville, MO 63501-2951 |
Second Address | Kirksville, MO 63501-2951 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |