Healthcare Provider Details

I. General information

NPI: 1679307318
Provider Name (Legal Business Name): THE COTTAGE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 US HIGHWAY 63
WILLOW SPRINGS MO
65793-9289
US

IV. Provider business mailing address

2916 US HIGHWAY 63
WILLOW SPRINGS MO
65793-9289
US

V. Phone/Fax

Practice location:
  • Phone: 417-616-3039
  • Fax:
Mailing address:
  • Phone: 417-616-3039
  • 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: JODI LYNNE DANCER
Title or Position: OWNER/PRACTITIONER
Credential: LCSW
Phone: 530-598-8392