Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2010033339 | MO |
NPI | 1003107236 |
---|---|
Provider Name | Elma Katherine Mcbroom |
First Address | Clinton, MO 64735-8804 |
Second Address | Jefferson City, MO 65109-1134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2011 |
Last Update Date | 18/03/2021 |