Doctor Name: | MR. JERRY DALE WILMATH |
NPI Number: | 1447267299 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW LPC |
License Number: | LPC000167 |
Business Practice Address: | 2024 N 14 Poplar Bluff, MO - 63901 |
Business Phone Number: | 5737189315 |
Business Fax Number: | 5736862647 |
Mailing Address: | 2024 N 14, POPLAR BLUFF |
State: | MO |
Postal Code: | 63901 |
Phone Number: | 5737189315 |
Fax Number: | 5736862647 |
NPI Enumeration Date: | 08/02/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | LPC000167 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |