=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548177157
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALLY A SCRIVENER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2026
-----------------------------------------------------
Last Update Date | 08/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2728 E CHESTNUT EXPY
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65802-2555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-848-1756
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 SPRING HILLS ST
-----------------------------------------------------
City | MARSHFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65706-7538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-215-2486
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 2026041510
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------