Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 794 | KS |
Y | 103TC0700X | Clinical Psychologist | 794 | KS |
N | 103G00000X | Clinical Psychologist | PYRO327 | MO |
N | 103TC0700X | Clinical Psychologist | PYRO327 | MO |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 794 | KS |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PYRO327 | MO |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 794 | KS |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PYRO327 | MO |
N | 103G00000X | Clinical Psychologist | 794 | KS |
N | 103TC0700X | Clinical Psychologist | 794 | KS |
N | 103G00000X | Clinical Psychologist | PYRO327 | MO |
N | 103TC0700X | Clinical Psychologist | PYRO327 | MO |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 794 | KS |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PYRO327 | MO |
N | 103TF0200X | Forensic Psychologist | 794 | KS |
N | 103TF0200X | Forensic Psychologist | PYRO327 | MO |
NPI | 1134328420 |
---|---|
Provider Name | Dr. David R. Mouille |
First Address | Shawnee, KS 66216-1235 |
Second Address | Shawnee, KS 66216-1235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2007 |
Last Update Date | 16/07/2007 |