Provider Demographics
NPI:1346767407
Name:PIERSON-POE, ELIZABETH ANN
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:PIERSON-POE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:MO
Mailing Address - Zip Code:64465-9770
Mailing Address - Country:US
Mailing Address - Phone:816-399-9952
Mailing Address - Fax:
Practice Address - Street 1:703 SHORT ST
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:MO
Practice Address - Zip Code:64465-9770
Practice Address - Country:US
Practice Address - Phone:816-399-9952
Practice Address - Fax:816-399-9952
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170139891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical