Healthcare Provider Details

I. General information

NPI: 1639036213
Provider Name (Legal Business Name): CECILIA NEO CORBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3854 SOUTH AVE STE C
SPRINGFIELD MO
65807-5285
US

IV. Provider business mailing address

3854 SOUTH AVE STE C
SPRINGFIELD MO
65807-5285
US

V. Phone/Fax

Practice location:
  • Phone: 417-215-2818
  • Fax:
Mailing address:
  • Phone: 417-215-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2025026510
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: