Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | 2001011582 | MO |
Y | 101YP2500X | Professional Counselor | 2001011582 | MO |
NPI | 1184730137 |
---|---|
Provider Name | Mrs. Karen D. Wasoba |
First Address | Saint Charles, MO 63303-5627 |
Second Address | Saint Charles, MO 63303-5627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 30/04/2014 |