Provider Demographics
NPI:1447124391
Name:THE EAGLESNEST 3C
Entity type:Organization
Organization Name:THE EAGLESNEST 3C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER. CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:QUINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:417-861-3965
Mailing Address - Street 1:743 W RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4658
Mailing Address - Country:US
Mailing Address - Phone:417-861-3965
Mailing Address - Fax:
Practice Address - Street 1:743 W RIVERSIDE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4658
Practice Address - Country:US
Practice Address - Phone:417-861-3965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health