Provider Demographics
NPI:1871897728
Name:OZARK MOUNTAIN COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:OZARK MOUNTAIN COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:417-846-0700
Mailing Address - Street 1:404 STATE HWY 248
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CASSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65625-9615
Mailing Address - Country:US
Mailing Address - Phone:417-846-0700
Mailing Address - Fax:
Practice Address - Street 1:404-5 STATE HWY. 248
Practice Address - Street 2:SUITE 5
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625-9615
Practice Address - Country:US
Practice Address - Phone:417-846-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW001710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1326057977Medicaid
MO150990004Medicare PIN