Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 2014030995 | MO |
NPI | 1164823761 |
---|---|
Provider Name | Katera Mowry |
First Address | Lebanon, MO 65536-4669 |
Second Address | Lebanon, MO 65536-4669 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2014 |
Last Update Date | 11/12/2015 |