Individual
MR. ALEXANDER MARK PROROK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
3670 COUNTY ROAD 4990, WILLOW SPRINGS, MO 65793-0506
(417) 469-2951
Mailing address
3670 COUNTY ROAD 4990, WILLOW SPRINGS, MO 65793-0506
(417) 469-2951
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2002032260
MO
251C00000X
Developmentally Disabled Services Day Training Agency
2002032260
MO
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2002032260
MO
3747P1801X
Personal Care Attendant
2002032260
MO
385H00000X
Respite Care
2002032260
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
498342609
—
MO
05
—
858342603
—
MO
Enumeration date
12/28/2005
Last updated
08/26/2008
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