Healthcare Provider Details

I. General information

NPI: 1104504646
Provider Name (Legal Business Name): ANTHONY C NORRIS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5634 W SUGAR PINE DR
SPRINGFIELD MO
65802-7813
US

IV. Provider business mailing address

5634 W SUGAR PINE DR
SPRINGFIELD MO
65802-7813
US

V. Phone/Fax

Practice location:
  • Phone: 417-849-5395
  • Fax:
Mailing address:
  • Phone: 417-849-5395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025009754
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2020036116
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: