Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2004037122 | MO |
NPI | 1982169199 |
---|---|
Provider Name | Mr. Kevin Lynn White JR. |
First Address | Wentzville, MO 63385-3421 |
Second Address | Wentzville, MO 63385-3421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2019 |
Last Update Date | 01/02/2019 |