Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC-11861 | AZ |
NPI | 1003854035 |
---|---|
Provider Name | Ms. Keri Jo Mcwethy |
First Address | Yuma, AZ 85365-7748 |
Second Address | Yuma, AZ 85365-7748 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
929101 | AHCCCS # (01) | AZ |