Healthcare Provider Details

I. General information

NPI: 1174209423
Provider Name (Legal Business Name): CPR IN THE OZARKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 S CAMPBELL AVE
SPRINGFIELD MO
65807-2903
US

IV. Provider business mailing address

2407 S CAMPBELL AVE
SPRINGFIELD MO
65807-2903
US

V. Phone/Fax

Practice location:
  • Phone: 417-413-1470
  • Fax:
Mailing address:
  • Phone: 417-413-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KARISSA COPPEDGE
Title or Position: CO-OWNER
Credential:
Phone: 417-413-1470