Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2007030009 | MO |
Y | 103G00000X | Clinical Psychologist | 2007030009 | MO |
Y | 103TC0700X | Clinical Psychologist | 2007030009 | MO |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2007030009 | MO |
N | 103TH0100X | Health Service | 2007030009 | MO |
N | 103TP2701X | Group Psychotherapist | 2007030009 | MO |
N | 103TR0400X | Rehabilitation Psychologist | 2007030009 | MO |
NPI | 1770773459 |
---|---|
Provider Name | Joann Mcguire |
First Address | Springfield, MO 65807-7311 |
Second Address | Springfield, MO 65807-7347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2007 |
Last Update Date | 08/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
494925704 | (05) | MO |