MEDICARE: SEEDS OF HOPE COUNSELING SERVICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1346938164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEEDS OF HOPE COUNSELING SERVICE LLC

Provider Business Mailing Address
First Line	:	3854 SOUTH AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5285
Country	:	US
Telephone Number	:	417-215-2818
Fax Number	:

Provider Business Practice Location Address
First Line	:	3854 SOUTH AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5285
Country	:	US
Telephone Number	:	417-215-2818
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	LORISA EBY
Credential	:	LCSW
Telephone Number	:	224-577-9203

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	10/31/2023

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