Healthcare Provider Details

I. General information

NPI: 1780965509
Provider Name (Legal Business Name): FAMILY THERAPY OF THE OZARKS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 E. KINGSLEY SUITE C
SPRINGFIELD MO
65804-7238
US

IV. Provider business mailing address

1310 E KINGSLEY ST SUITE C
SPRINGFIELD MO
65804-7216
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-7700
  • Fax: 417-885-3956
Mailing address:
  • Phone: 417-882-7700
  • Fax: 417-885-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE LEA BOLING
Title or Position: CO-OWNER/THERAPIST
Credential: MSW, LCSW
Phone: 417-882-7700