The holder whose full name is SOUTHWELL, EUGENE ALLEN,come from VALPARAISO IN,hold the Psychologist - Health Service Provider license(NO.20010102A) which status is Expired.
| Name | SOUTHWELL, EUGENE ALLEN |
|---|---|
| License Number | 20010102A |
| License Type | Psychologist - Health Service Provider |
| License Status | Expired |
| City | VALPARAISO |
| State | IN |