Healthcare Provider Details

I. General information

NPI: 1982915328
Provider Name (Legal Business Name): KOINONIA KOUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 KEEVEN DR
CASSVILLE MO
65625-9766
US

IV. Provider business mailing address

PO BOX 688
CASSVILLE MO
65625-0688
US

V. Phone/Fax

Practice location:
  • Phone: 417-342-0951
  • Fax: 417-847-6510
Mailing address:
  • Phone: 417-342-0951
  • Fax: 417-847-6510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2007020855
License Number StateMO

VIII. Authorized Official

Name: JACQUELINE JEAN SCHNEDLER
Title or Position: MEMBER
Credential: MSW, LCSW
Phone: 417-342-0951