Healthcare Provider Details

I. General information

NPI: 1871641563
Provider Name (Legal Business Name): WOODROW WILSON YOUNTS III LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5281 S 120TH RD
MORRISVILLE MO
65710-9203
US

IV. Provider business mailing address

5281 S 120TH RD
MORRISVILLE MO
65710-9203
US

V. Phone/Fax

Practice location:
  • Phone: 417-844-3588
  • Fax: 417-283-2054
Mailing address:
  • Phone: 417-844-3588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2005010722
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: