Healthcare Provider Details

I. General information

NPI: 1477375855
Provider Name (Legal Business Name): CM COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 W 26TH ST
JOPLIN MO
64804-0398
US

IV. Provider business mailing address

1627 W 26TH ST
JOPLIN MO
64804-0398
US

V. Phone/Fax

Practice location:
  • Phone: 417-627-9601
  • Fax: 417-627-9032
Mailing address:
  • Phone: 417-627-9601
  • Fax: 417-627-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. CYDNEY CHURCHWELL
Title or Position: OWNER
Credential: LPC
Phone: 417-627-9601