Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 846 | WV |
N | 103T00000X | Psychologist | 846 | WV |
N | 103TS0200X | School Psychologist | 0803000189 | VA |
NPI | 1053412510 |
---|---|
Provider Name | Teresa E. Jarrell |
First Address | Bluefield, WV 24701-3747 |
Second Address | Bluefield, WV 24701-3747 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9202138000 | (05) | WV |