Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 37639 | TX |
NPI | 1063972081 |
---|---|
Provider Name | Dr. Marianela Dornhecker |
First Address | Saint Louis, MO 63163-3174 |
Second Address | Saint Louis, MO 63116-4717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2019 |
Last Update Date | 18/10/2020 |