Healthcare Provider Details

I. General information

NPI: 1326122961
Provider Name (Legal Business Name): OZARK CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 SNOWBERRY LANE
JOPLIN MO
64803-2526
US

IV. Provider business mailing address

PO BOX 2526
JOPLIN MO
64803-2526
US

V. Phone/Fax

Practice location:
  • Phone: 417-781-0821
  • Fax: 417-625-8421
Mailing address:
  • Phone: 417-781-0821
  • Fax: 417-625-8421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCS001675
License Number StateMO

VIII. Authorized Official

Name: FREDERICK NICK MEYER JR.
Title or Position: CLINICAL SUPERVISOR
Credential: LPC
Phone: 417-781-0821