Healthcare Provider Details

I. General information

NPI: 1508204678
Provider Name (Legal Business Name): CENTER FOR TRANSITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4432 W JUNO ST
SPRINGFIELD MO
65802-5657
US

IV. Provider business mailing address

4432 W JUNO ST
SPRINGFIELD MO
65802-5657
US

V. Phone/Fax

Practice location:
  • Phone: 417-350-6860
  • Fax:
Mailing address:
  • Phone: 417-350-6860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011001218
License Number StateMO

VIII. Authorized Official

Name: JOSHUA D CASTILLO
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 417-350-6860