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General NPI Number Information
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NPI Number | 1023428885
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Entity Type | Individual
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Provider Name | NAKITA BROSS
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Gender | Female
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 655 CLINIC RD STE 201
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City | HANNIBAL
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State | MO
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Zip | 63401-3647
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Country | US
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Telephone | 573-621-3116
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Fax | 573-303-0125
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Provider Business Mailing Address
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Address Line | 655 CLINIC RD STE 201
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City | HANNIBAL
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State | MO
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Zip | 63401-3647
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Country | US
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Telephone | 573-621-3116
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Fax | 573-303-0125
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2022002915
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2022006794
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180010965
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166001104
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License Number State | IL
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