Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1003282351 |
---|---|
Provider Name | Emily May Van Ness Konecky |
First Address | Waco, TX 76711-1329 |
Second Address | Waco, TX 76711-1329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2015 |
Last Update Date | 14/09/2015 |