Organization
BEHAVIORAL AND INTEGRATIVE HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE MARSHALL (EMPLOYEE)
(941) 237-7174
Entity
Organization
Contact information
Practice address
313 SOUTH AVE STE 300, SPRINGFIELD, MO 65806-2162
(941) 237-7174
Mailing address
313 SOUTH AVE STE 300, SPRINGFIELD, MO 65806-2162
(941) 237-7174
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013875200
—
FL
01
—
1126078
WELLCARE
FL
01
—
819448
BEACON
—
Enumeration date
06/25/2021
Last updated
06/25/2021
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