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General NPI Number Information
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NPI Number | 1154001469
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Entity Type | Organization
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Legal Business Name | FREE YOUR MIND THERAPY LLC
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Dates
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Enumeration Date | 07/20/2023
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 910 E SAN MARTIN ST OFC 2
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City | BOLIVAR
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State | MO
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Zip | 65613-2893
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Country | US
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Telephone | 417-414-0676
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Fax | 844-222-4909
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Provider Business Mailing Address
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Address Line | 910 E SAN MARTIN ST OFC 2
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City | BOLIVAR
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State | MO
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Zip | 65613-2893
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Country | US
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Telephone | 417-414-0676
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Fax | 844-222-4909
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Authorized Official
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Title or Position | LCSW/OWNER
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Name | KIMBERLY A KANNA
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Credential | LCSW
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Telephone | 417-414-0676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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