Healthcare Provider Details

I. General information

NPI: 1710136270
Provider Name (Legal Business Name): MYRA J BAUER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MYRA J STOVALL LCSW

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 N 22ND ST
OZARK MO
65721-8662
US

IV. Provider business mailing address

708 N 22ND ST
OZARK MO
65721-8662
US

V. Phone/Fax

Practice location:
  • Phone: 479-518-2328
  • Fax: 479-755-3782
Mailing address:
  • Phone: 479-518-2328
  • Fax: 479-755-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2020017505
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3189-C
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: