Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 2009016901 | MO |
NPI | 1003047317 |
---|---|
Provider Name | Vera M Holder |
First Address | Trenton, MO 64683-0030 |
Second Address | Trenton, MO 64683-1178 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2009 |
Last Update Date | 04/08/2009 |