Healthcare Provider Details

I. General information

NPI: 1376492017
Provider Name (Legal Business Name): SOUTHWEST MISSOURI SPECIALTY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 8TH ST
WASHBURN MO
65772-7911
US

IV. Provider business mailing address

503 8TH ST
WASHBURN MO
65772-7911
US

V. Phone/Fax

Practice location:
  • Phone: 636-578-7725
  • Fax: 636-578-7725
Mailing address:
  • Phone: 636-578-7725
  • Fax: 636-578-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. BRANDACE L HAYWORTH
Title or Position: DIRECTOR
Credential: RBT
Phone: 636-578-7725