Healthcare Provider Details

I. General information

NPI: 1740586551
Provider Name (Legal Business Name): JOSEPH LEE HACKWORTH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 INDEPENDENCE DR
WEST PLAINS MO
65775-4221
US

IV. Provider business mailing address

1137 INDEPENDENCE DR
WEST PLAINS MO
65775-4221
US

V. Phone/Fax

Practice location:
  • Phone: 417-255-8464
  • Fax:
Mailing address:
  • Phone: 417-255-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: