Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | ||
Y | 103TC0700X | Clinical Psychologist |
NPI | 1003410655 |
---|---|
Provider Name | Dr. Cole Honeyman |
First Address | Flora, IL 62839-1093 |
Second Address | Flora, IL 62839-1093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2020 |
Last Update Date | 30/11/2020 |