| Southern Light Residential | |
|
1211 E Broadway St Bolivar MO 65613-2952 | |
| (417) 850-4555 | |
| (417) 777-7017 |
| Full Name | Southern Light Residential |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1211 E Broadway St, Bolivar, Missouri |
| Authorized Official Name and Position | Cindy Drake (ADMIN DIRECTOR) |
| Authorized Official Contact | 4178504555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Light Residential 707 S Pearl Ave Joplin MO 64801-4334 Ph: (417) 850-4555 | Southern Light Residential 1211 E Broadway St Bolivar MO 65613-2952 Ph: (417) 850-4555 |
| NPI Number | 1801312459 |
|---|---|
| Provider Enumeration Date | 08/16/2017 |
| Last Update Date | 08/16/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801312459 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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