Healthcare Provider Details

I. General information

NPI: 1710271622
Provider Name (Legal Business Name): LAWRENCE M MCDANIEL MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 W COBBLEFIELD WAY
OZARK MO
65721-7222
US

IV. Provider business mailing address

1114 W COBBLEFIELD WAY
OZARK MO
65721-7222
US

V. Phone/Fax

Practice location:
  • Phone: 573-200-6756
  • Fax:
Mailing address:
  • Phone: 573-200-6756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011015195
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: