Healthcare Provider Details

I. General information

NPI: 1154576908
Provider Name (Legal Business Name): PAULA SYKES MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 OUTER RD
MOUNTAIN GROVE MO
65711-2516
US

IV. Provider business mailing address

8401 OUTER RD
MOUNTAIN GROVE MO
65711-2516
US

V. Phone/Fax

Practice location:
  • Phone: 417-926-1500
  • Fax: 417-926-1538
Mailing address:
  • Phone: 417-926-1500
  • Fax: 417-926-1538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: