Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701005000 | VA |
N | 101YP2500X | Professional Counselor | 2013014281 | MO |
NPI | 1003171984 |
---|---|
Provider Name | Ryan T Neace |
First Address | Saint Louis, MO 63109-3571 |
Second Address | Saint Louis, MO 63109-3571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2012 |
Last Update Date | 10/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12399247 | CAQH PROVIDER ID (01) |