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General NPI Number Information
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NPI Number | 1164567269
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Entity Type | Organization
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Legal Business Name | APPLEWOOD LANE CORPORATION
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18811 HIGHWAY 32
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City | LEBANON
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State | MO
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Zip | 65536-8102
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Country | US
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Telephone | 417-589-4211
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Fax | 417-532-7816
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Provider Business Mailing Address
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Address Line | 27 HOPPER TRL
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City | URBANA
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State | MO
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Zip | 65767-9234
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Country | US
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Telephone | 417-722-4416
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Fax | 417-722-4417
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GARY D BOGGS
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Credential |
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Telephone | 417-722-4416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 38134001058360
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License Number State | MO
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