Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2009007303 | MO |
NPI | 1003325317 |
---|---|
Provider Name | Laura Jean South |
First Address | Carthage, MO 64836-7679 |
Second Address | Carthage, MO 64836-7679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2017 |
Last Update Date | 29/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2009007303 | LICENSED PROFESSIONAL COUNSELOR (01) | MO |