| NPI | 1770139735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROCK SHAMEL Vice President 417-269-4368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TC0700X Psychologist Clinical | |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2025-06-17 |