Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1025 | MO |
Y | 103TC0700X | Clinical Psychologist | 1025 | MO |
NPI | 1013030303 |
---|---|
Provider Name | Dr. James Robert Powers |
First Address | Ellisville, MO 63021-4767 |
Second Address | Ellisville, MO 63021-4767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 08/07/2007 |