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General NPI Number Information
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NPI Number | 1780965509
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Entity Type | Organization
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Legal Business Name | FAMILY THERAPY OF THE OZARKS, INC
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 1310 E. KINGSLEY SUITE C
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City | SPRINGFIELD
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State | MO
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Zip | 65804-7238
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Country | US
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Telephone | 417-882-7700
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Fax | 417-885-3956
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Provider Business Mailing Address
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Address Line | 1310 E KINGSLEY ST SUITE C
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City | SPRINGFIELD
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State | MO
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Zip | 65804-7216
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Country | US
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Telephone | 417-882-7700
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Fax | 417-885-3956
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Authorized Official
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Title or Position | CO-OWNER/THERAPIST
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Name | CATHERINE LEA BOLING
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Credential | MSW, LCSW
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Telephone | 417-882-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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