Healthcare Provider Details

I. General information

NPI: 1245185479
Provider Name (Legal Business Name): GOLDEN VALLEY SERENITY SPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W JEFFERSON ST
CLINTON MO
64735-2061
US

IV. Provider business mailing address

116 W JEFFERSON ST
CLINTON MO
64735-2061
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-3885
  • Fax:
Mailing address:
  • Phone: 660-885-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JANE HARRISON
Title or Position: MASSAGE THERAPY
Credential:
Phone: 660-885-3885