Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2021030439 | MO |
NPI | 1003587635 |
---|---|
Provider Name | Jenna Masters |
First Address | Arnold, MO 63010-2505 |
Second Address | Saint Louis, MO 63129-3646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2021 |
Last Update Date | 23/09/2021 |