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General NPI Number Information
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NPI Number | 1336393669
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Entity Type | Organization
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Legal Business Name | PRAISE ASSEMBY
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 2032 E KEARNEY ST STE 214
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City | SPRINGFIELD
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State | MO
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Zip | 65803-4662
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Country | US
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Telephone | 417-833-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 4010 W HARRISON ST
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City | SPRINGFIELD
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State | MO
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Zip | 65802-5756
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Country | US
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Telephone | 417-619-8921
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | MR. TIM LYONS
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Credential | MA.
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Telephone | 417-833-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2008032814
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 2008032814
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License Number State | MO
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