Healthcare Provider Details

I. General information

NPI: 1003775792
Provider Name (Legal Business Name): UNBOUND HORIZON OUTPATIENT SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 S GRAND AVE
CARTHAGE MO
64836-7803
US

IV. Provider business mailing address

2929 S GRAND AVE
CARTHAGE MO
64836-7803
US

V. Phone/Fax

Practice location:
  • Phone: 417-540-4915
  • Fax:
Mailing address:
  • Phone: 417-540-4915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ASEFA GEBRE
Title or Position: OWNER
Credential: PHYSICIAN ASSISTANT
Phone: 417-540-4915