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General NPI Number Information
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NPI Number | 1326122961
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Entity Type | Organization
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Legal Business Name | OZARK CENTER
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1949 SNOWBERRY LANE
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City | JOPLIN
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State | MO
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Zip | 64803-2526
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Country | US
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Telephone | 417-781-0821
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Fax | 417-625-8421
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Provider Business Mailing Address
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Address Line | PO BOX 2526
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City | JOPLIN
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State | MO
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Zip | 64803-2526
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Country | US
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Telephone | 417-781-0821
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Fax | 417-625-8421
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | FREDERICK NICK MEYER JR.
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Credential | LPC
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Telephone | 417-781-0821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CS001675
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License Number State | MO
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