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Organization
THE MIND AND BODY CLINIC
Active
Organization
THE MIND AND BODY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH BROOKE MARTIN LCSW (OWNER/CLINICIAN)
(417) 655-5847
Entity
Organization
Contact information
Practice address
3804 S COX RD., SPRINGFIELD, MO 65807-8603
(417) 812-6850
Mailing address
3804 S COX RD., SPRINGFIELD, MO 65807-8603
(417) 812-6850
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008034202
COMMITTEE FOR PROFESSIONAL COUNSELORS
MO
01
—
2018013556
MO LICENSE NUMBER
MO
01
—
2019031487
COMMITTEE FOR SOCIAL WORKERS
MO
01
—
2020005419
COMMITTEE FOR SOCIAL WORKERS
MO
Enumeration date
11/05/2021
Last updated
07/31/2023
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