Healthcare Provider Details

I. General information

NPI: 1295775658
Provider Name (Legal Business Name): HEALTHY LIVING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 E 18TH ST SUITE 104
HIGGINSVILLE MO
64037-1358
US

IV. Provider business mailing address

14 E 18TH ST SUITE 104
HIGGINSVILLE MO
64037-1358
US

V. Phone/Fax

Practice location:
  • Phone: 660-584-5560
  • Fax: 660-584-5562
Mailing address:
  • Phone: 660-584-5560
  • Fax: 660-584-5562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number00404
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN043218
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN043218
License Number StateMO

VIII. Authorized Official

Name: DR. FRANCES DEAN ATKINS
Title or Position: PRESIDENT
Credential: RN PSYCH/M.H.
Phone: 660-584-5560