Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 2017008233 | MO |
NPI | 1992229520 |
---|---|
Provider Name | Rebecca Lynn Coulson |
First Address | Clinton, MO 64735-8804 |
Second Address | Wentzville, MO 63385 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2017 |
Last Update Date | 26/09/2019 |