Healthcare Provider Details

I. General information

NPI: 1760336366
Provider Name (Legal Business Name): EMBER AND ASH INTEGRATIVE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E REPUBLIC RD STE A130
SPRINGFIELD MO
65804-6582
US

IV. Provider business mailing address

396 MAYNARD RD
NIXA MO
65714-7267
US

V. Phone/Fax

Practice location:
  • Phone: 417-880-9481
  • Fax:
Mailing address:
  • Phone: 417-880-9481
  • Fax: 417-855-8229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RIKI LEE CLARK
Title or Position: MANAGING MEMBER
Credential: PMHNP
Phone: 417-880-9481