Doctor Name: | ROBERT P. WISSORE |
NPI Number: | 1154462455 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 000577 |
Business Practice Address: | 102 S Interstate Dr Sikeston, MO - 63801 |
Business Phone Number: | 5734723400 |
Business Fax Number: | 5734722937 |
Mailing Address: | Route 1 Box 28, MARQUAND |
State: | MO |
Postal Code: | 63655 |
Phone Number: | 5738662767 |
Fax Number: | 5734722937 |
NPI Enumeration Date: | 02/09/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 000577 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |