Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1013270578 |
---|---|
Provider Name | Jocelyn N Abanes |
First Address | Columbia, MO 65201-5275 |
Second Address | Columbia, MO 65201-5275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 20/06/2012 |