Healthcare Provider Details

I. General information

NPI: 1245404326
Provider Name (Legal Business Name): TRESSA MOYLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 N JEFFERSON AVE
SPRINGFIELD MO
65802-1917
US

IV. Provider business mailing address

1423 N JEFFERSON AVE
SPRINGFIELD MO
65802-1917
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-2273
  • Fax:
Mailing address:
  • Phone: 417-269-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2002016387
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: