MEDICARE: MISSOURI EMPOWERMENT PROJECT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	104100000X	Social Worker
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1114791134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURI EMPOWERMENT PROJECT

Provider Business Mailing Address
First Line	:	2407 S CAMPBELL AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-2903
Country	:	US
Telephone Number	:	417-380-3652
Fax Number	:

Provider Business Practice Location Address
First Line	:	3623 SOUTH AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5220
Country	:	US
Telephone Number	:	417-380-3652
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KARISSA COPPEDGE
Credential	:
Telephone Number	:	417-380-3652

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	11/09/2023

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Directions to “MISSOURI EMPOWERMENT PROJECT ” Practice Location

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