Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 1999135679 | MO |
N | 101YP1600X | Pastoral Counselor | 6015 | VA |
NPI | 1275629925 |
---|---|
Provider Name | Randal Demasters |
First Address | Kansas City, MO 64145-1455 |
Second Address | Kansas City, MO 64145-1455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 26/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
494845811 | (05) | MO |