=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578056370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TREETOP COUNSELING AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2018
-----------------------------------------------------
Last Update Date | 07/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1868 N COMMERCE DR
-----------------------------------------------------
City | NIXA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-501-6867
-----------------------------------------------------
Fax | 417-374-0047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1868 N COMMERCE DR
-----------------------------------------------------
City | NIXA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65714-7603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-501-6867
-----------------------------------------------------
Fax | 417-374-0047
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | DR. CHRISTOPHER M WARD
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 417-501-6867
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 2014031837
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------