Healthcare Provider Details

I. General information

NPI: 1043696891
Provider Name (Legal Business Name): LUTHERAN FAMILY AND CHILDREN'S SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 N GLENSTONE AVE
SPRINGFIELD MO
65803-4646
US

IV. Provider business mailing address

2130 N GLENSTONE AVE
SPRINGFIELD MO
65803-4646
US

V. Phone/Fax

Practice location:
  • Phone: 417-862-1972
  • Fax: 417-862-3276
Mailing address:
  • Phone: 417-862-1972
  • Fax: 417-862-3276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURA FARMER
Title or Position: REGIONAL DIRECTOR
Credential: MSW, LCSW
Phone: 417-862-1972