Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | LCP 934 | KS |
NPI | 1073776910 |
---|---|
Provider Name | Mrs. Michelle Lea Raine |
First Address | Newton, KS 67114-5010 |
Second Address | Newton, KS 67114-5010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 09/11/2011 |