Healthcare Provider Details

I. General information

NPI: 1295625259
Provider Name (Legal Business Name): LAUREL MASSEY MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 RYAN ST STE W
BOONVILLE MO
65233-1894
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-7573
  • Fax:
Mailing address:
  • Phone: 417-761-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025013695
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: