| Counseling Group Of The Ozarks | |
|
1901 E Bennett St Ste B Springfield MO 65804-1427 | |
| (417) 409-3008 | |
| (417) 719-7973 |
| Full Name | Counseling Group Of The Ozarks |
|---|---|
| Speciality | Counselor |
| Location | 1901 E Bennett St Ste B, Springfield, Missouri |
| Authorized Official Name and Position | Labryon Williams (OWNER) |
| Authorized Official Contact | 4174093008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Counseling Group Of The Ozarks 1901 E Bennett St Ste B Springfield MO 65804-1427 Ph: (417) 379-0387 | Counseling Group Of The Ozarks 1901 E Bennett St Ste B Springfield MO 65804-1427 Ph: (417) 409-3008 |
| NPI Number | 1174082366 |
|---|---|
| Provider Enumeration Date | 03/18/2019 |
| Last Update Date | 01/10/2023 |
| Certification Date | 01/10/2023 |
| Medicare PECOS PAC ID | 8325471717 |
|---|---|
| Medicare Enrollment ID | O20191125001406 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174082366 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Paula Lynne Wiesehan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144348954 PECOS PAC ID: 3476658337 Enrollment ID: I20070420000455 |
| Provider Name | Brian M Braumiller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710181029 PECOS PAC ID: 5799751855 Enrollment ID: I20120529000220 |
| Provider Name | Rachella J Mcclain |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124333919 PECOS PAC ID: 6406165075 Enrollment ID: I20151021002567 |
| Provider Name | Amelia Lo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871011825 PECOS PAC ID: 1658708227 Enrollment ID: I20200219002881 |
| Provider Name | Robyn Taft |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962977488 PECOS PAC ID: 8527418169 Enrollment ID: I20231222002156 |
| Provider Name | Labryon Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720264559 PECOS PAC ID: 7315370707 Enrollment ID: I20240104001732 |
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