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General NPI Number Information
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NPI Number | 1265365530
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Entity Type | Organization
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Legal Business Name | REGENERATION WELLNESS LLC
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Dates
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Enumeration Date | 06/05/2026
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Last Update Date | 06/05/2026
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Provider Practice Location Address
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Address Line | 1909 E BENNETT ST STE 104
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City | SPRINGFIELD
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State | MO
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Zip | 65804-1400
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Country | US
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Telephone | 417-231-5723
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Fax |
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Provider Business Mailing Address
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Address Line | 723 N OAK GROVE AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65802-2367
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Country | US
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Telephone | 417-231-5723
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA GRIM
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Credential | LPC
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Telephone | 417-231-5723
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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 |
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License Number State |
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