Healthcare Provider Details

I. General information

NPI: 1710276845
Provider Name (Legal Business Name): TORIE NICOLE VANPOOL M.A, P.L.P.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 N MOUNT AUBURN RD SUITE C
CAPE GIRARDEAU MO
63701-1727
US

IV. Provider business mailing address

1353 N MOUNT AUBURN RD SUITE C
CAPE GIRARDEAU MO
63701-1727
US

V. Phone/Fax

Practice location:
  • Phone: 573-803-1402
  • Fax: 573-803-1405
Mailing address:
  • Phone: 573-803-1402
  • Fax: 573-803-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2011008636
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: