Healthcare Provider Details

I. General information

NPI: 1417902305
Provider Name (Legal Business Name): NORTHWOODS PSYCHIATRIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E SAN MARTIN ST
BOLIVAR MO
65613-2893
US

IV. Provider business mailing address

PO BOX 49
BOLIVAR MO
65613-0049
US

V. Phone/Fax

Practice location:
  • Phone: 417-326-7272
  • Fax: 417-326-2193
Mailing address:
  • Phone: 417-326-7272
  • Fax: 417-326-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2004008720
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2003024990
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY01322
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2004015488
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR1J41
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number066643
License Number StateMO
# 8
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DENESE STRANGE
Title or Position: OFFICE MANAGER
Credential:
Phone: 417-326-7272