Doctor Name: | DR. GARY LEE JUNE |
NPI Number: | 1124033725 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSYD |
License Number: | 2003030081 |
Business Practice Address: | 528 S Eagan St Republic, MO - 657381876 |
Business Phone Number: | 4172344608 |
Business Fax Number: | |
Mailing Address: | 528 S Eagan St, REPUBLIC |
State: | MO |
Postal Code: | 657381876 |
Phone Number: | 4172344608 |
Fax Number: | |
NPI Enumeration Date: | 07/30/2006 |
NPI Last Update Date: | 01/19/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 2003030081 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |