Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 2420 | WV |
NPI | 1043761711 |
---|---|
Provider Name | Lawrence Lester |
First Address | Princeton, WV 24740-3065 |
Second Address | Princeton, WV 24740-3065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2016 |
Last Update Date | 18/10/2016 |