Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | 2013004224 | MO |
Y | 101YP2500X | Professional Counselor | 2013004224 | MO |
NPI | 1043554934 |
---|---|
Provider Name | Eric Joseph Staples |
First Address | Branson, MO 65616-2518 |
Second Address | Branson, MO 65616-2518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2012 |
Last Update Date | 16/04/2013 |