Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 2011032755 | MO |
Y | 103G00000X | Clinical Psychologist | 2011037832 | MO |
Y | 103TC0700X | Clinical Psychologist | 2011037832 | MO |
NPI | 1003192535 |
---|---|
Provider Name | Theta P Gribbins |
First Address | Saint Charles, MO 63303-4099 |
Second Address | Saint Charles, MO 63303-4099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2011 |
Last Update Date | 08/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
232812942 | SAINT LOUIS BEHAVIORAL MEDICINE INSTITUTE (01) | MO |
46-0760135 | ST CHARLES PSYCH TESTING & THERAPY (01) | MO |