Healthcare Provider Details

I. General information

NPI: 1639820319
Provider Name (Legal Business Name): RAPHAEL DROZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22302 LAWRENCE 1130
VERONA MO
65769-8147
US

IV. Provider business mailing address

22302 LAWRENCE 1130
VERONA MO
65769-8147
US

V. Phone/Fax

Practice location:
  • Phone: 208-613-4773
  • Fax:
Mailing address:
  • Phone: 417-308-6548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: