Healthcare Provider Details

I. General information

NPI: 1831834126
Provider Name (Legal Business Name): MATTHEW VERMILLION
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2022
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 BRANSON HILLS PKWY STE 104
BRANSON MO
65616-4189
US

IV. Provider business mailing address

165 BUZZ ST UNIT 17
BRANSON MO
65616-6718
US

V. Phone/Fax

Practice location:
  • Phone: 417-336-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2025047466
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: