Healthcare Provider Details

I. General information

NPI: 1255969440
Provider Name (Legal Business Name): HEALING CONNECTIONS COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 02/28/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17019 MO 5 SUITE C
SUNRISE BEACH MO
65079-0802
US

IV. Provider business mailing address

PO BOX 802
SUNRISE BEACH MO
65079-0802
US

V. Phone/Fax

Practice location:
  • Phone: 573-207-4901
  • Fax: 573-207-4921
Mailing address:
  • Phone: 573-207-4901
  • Fax: 573-207-4921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHELE LYNNE CLARY
Title or Position: OWNER
Credential: LPC
Phone: 573-216-3919