Healthcare Provider Details

I. General information

NPI: 1699604587
Provider Name (Legal Business Name): SHOUSE THERAPEUTIC BEHAVIORAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 E BATTLEFIELD RD
SPRINGFIELD MO
65804-3982
US

IV. Provider business mailing address

5156 S WALNUT HILL RD
SPRINGFIELD MO
65810-2008
US

V. Phone/Fax

Practice location:
  • Phone: 708-921-8710
  • Fax:
Mailing address:
  • Phone: 708-921-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: AMANDA SHOUSE
Title or Position: EXECUTIVE DIRECTOR/OWNER
Credential: EDD
Phone: 708-921-8710