Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 1658 | MO |
NPI | 1134256910 |
---|---|
Provider Name | Dr. Elizabeth C Ewers Teel |
First Address | Jefferson City, MO 65109-5712 |
Second Address | Jefferson City, MO 65109-5712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 27/05/2015 |