Healthcare Provider Details

I. General information

NPI: 1346091204
Provider Name (Legal Business Name): DRAGON FLY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15276 W FARM ROAD 38
ASH GROVE MO
65604-8742
US

IV. Provider business mailing address

15276 W FARM ROAD 38
ASH GROVE MO
65604-8742
US

V. Phone/Fax

Practice location:
  • Phone: 417-773-5474
  • Fax:
Mailing address:
  • Phone: 417-773-5474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHRYN LYNN VANHOOSER
Title or Position: CEO
Credential: LPC
Phone: 417-773-5474