=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376492017
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWEST MISSOURI SPECIALTY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2026
-----------------------------------------------------
Last Update Date | 01/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 503 8TH ST
-----------------------------------------------------
City | WASHBURN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65772-7911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-578-7725
-----------------------------------------------------
Fax | 636-578-7725
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 503 8TH ST
-----------------------------------------------------
City | WASHBURN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65772-7911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-578-7725
-----------------------------------------------------
Fax | 636-578-7725
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. BRANDACE L HAYWORTH
-----------------------------------------------------
Credential | RBT
-----------------------------------------------------
Telephone | 636-578-7725
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 261QD1600X
-----------------------------------------------------
Taxonomy Name | Developmental Disabilities Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------