| Whole And Balanced Therapy Services, Llc | |
|
1459 E Broadway St Bolivar MO 65613-2950 | |
| (417) 777-5314 | |
| (417) 777-5320 |
| Full Name | Whole And Balanced Therapy Services, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1459 E Broadway St, Bolivar, Missouri |
| Authorized Official Name and Position | Debra Ann Anderson (OWNER) |
| Authorized Official Contact | 4177775314 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Whole And Balanced Therapy Services, Llc Po Box 347 Bolivar MO 65613-0347 Ph: (417) 777-5314 | Whole And Balanced Therapy Services, Llc 1459 E Broadway St Bolivar MO 65613-2950 Ph: (417) 777-5314 |
| NPI Number | 1336197854 |
|---|---|
| Provider Enumeration Date | 05/05/2006 |
| Last Update Date | 02/22/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336197854 | NPI | - | NPPES |
| 504593609 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 2005038008 (Missouri) | Primary |
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