Organization
BOYS & GIRLS TOWN OF MISSOURI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARLA H. UNDERWOOD MS, LPC, NCC (THERAPIST)
(417) 865-1646
Entity
Organization
Contact information
Practice address
1212 W LOMBARD ST, SPRINGFIELD, MO 65806-2720
(417) 865-1646
Mailing address
426 N ALEXANDER AVE, REPUBLIC, MO 65738-1235
(417) 732-2416
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
002691
MO
Other
Enumeration date
11/28/2006
Last updated
08/22/2020
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