Individual
PHYLLIS M REESMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
15899 LOGANS LAKE RD, BOONVILLE, MO 65233-2866
(660) 882-2333
(550) 882-2333
Mailing address
117 N GARTH AVE, COLUMBIA, MO 65203-4103
(573) 443-2204
(573) 875-5851
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
000596
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538204904
BOONVILLE NPI
MO
01
—
1649269622
GROUP BILLING NPI
MO
01
—
203147
HEALTHLINK I.D. NUMBER
MO
01
—
22157
BCBS I.D. NUMBER
MO
01
—
3361
FEI I.D. NUMBER
MO
01
—
5763918
FIRST HEALTH I.D. NUMBER
MO
Enumeration date
07/26/2005
Last updated
07/13/2007
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