Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2007007260 | MO |
NPI | 1003118308 |
---|---|
Provider Name | William Lagrand |
First Address | Saint Louis, MO 63126-1528 |
Second Address | Saint Louis, MO 63126-1528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2010 |
Last Update Date | 19/11/2010 |