Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 00 | MO |
Y | 103TC0700X | Clinical Psychologist | 00 | MO |
NPI | 1003044215 |
---|---|
Provider Name | Karen Andre Johnston |
First Address | Saint Louis, MO 63125-4181 |
Second Address | Saint Louis, MO 63125-4181 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 25/06/2009 |