Healthcare Provider Details

I. General information

NPI: 1093860306
Provider Name (Legal Business Name): PAULA GENE SEXTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3503 N BOBOLINK DR
OZARK MO
65721-6214
US

IV. Provider business mailing address

3503 N BOBOLINK DR
OZARK MO
65721-6214
US

V. Phone/Fax

Practice location:
  • Phone: 417-224-6055
  • Fax: 417-581-0438
Mailing address:
  • Phone: 417-224-6055
  • Fax: 417-581-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2002013166
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: