Healthcare Provider Details

I. General information

NPI: 1093235640
Provider Name (Legal Business Name): BREWER COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 SPARROWHAWK RD
FORDLAND MO
65652-8382
US

IV. Provider business mailing address

317 SPARROWHAWK ROAD
FORDLAND MO
65652-8382
US

V. Phone/Fax

Practice location:
  • Phone: 417-880-8622
  • Fax: 417-708-8963
Mailing address:
  • Phone: 417-880-8622
  • Fax: 417-708-8963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number2000148997
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2000150524
License Number StateMO

VIII. Authorized Official

Name: MRS. MARCIA BREWER
Title or Position: COUNSELOR
Credential: LPC
Phone: 417-880-8622