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General NPI Number Information
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NPI Number | 1891381216
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Entity Type | Organization
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Legal Business Name | COUNTRYSIDE COUNSELING LLC
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Dates
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Enumeration Date | 12/19/2020
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 313 SOUTH AVE STE 405
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City | SPRINGFIELD
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State | MO
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Zip | 65806-2255
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Country | US
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Telephone | 417-597-4685
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Fax | 855-437-0772
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Provider Business Mailing Address
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Address Line | 3036 W COUNTRYSIDE DR
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City | SPRINGFIELD
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State | MO
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Zip | 65807-3936
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Country | US
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Telephone | 417-597-4685
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Fax | 855-437-0772
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA EDWARD FREEMAN
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Credential | LCSW
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Telephone | 417-597-4685
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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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