=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982549994
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFEPOINT LEBANON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2026
-----------------------------------------------------
Last Update Date | 04/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 158 N ADAMS AVE
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65536-3044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-991-2911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 158 N ADAMS AVE
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65536-3044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-991-2911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LEAD PASTOR
-----------------------------------------------------
Name | KELLY RHOADES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 417-991-2911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP1600X
-----------------------------------------------------
Taxonomy Name | Pastoral Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------