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General NPI Number Information
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NPI Number | 1770630188
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD MARRIAGE AND FAMILY INSTITUTE, LLC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3734 SOUTH AVE SUITE C
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City | SPRINGFIELD
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State | MO
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Zip | 65807-5221
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Country | US
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Telephone | 417-882-6767
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Fax | 417-882-6768
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Provider Business Mailing Address
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Address Line | 3734 SOUTH AVE SUITE C
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City | SPRINGFIELD
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State | MO
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Zip | 65807-5221
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Country | US
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Telephone | 417-882-6767
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Fax | 417-882-6768
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. WILLIAM K. BOYCE
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Credential | LPC
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Telephone | 417-882-6767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 001089
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License Number State | MO
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