Individual
JOHANNA MARIE WOMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA. LPC
Contact information
Practice address
520 RYAN ST STE W, BOONVILLE, MO 65233-1894
(660) 882-7573
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5065
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2010027678
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
494287808
—
MO
Enumeration date
10/07/2010
Last updated
08/22/2022
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