Individual
EWELL BRENT SUGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
1667 E VINCENT DR, SPRINGFIELD, MO 65804-4320
(417) 246-2213
Mailing address
1667 E VINCENT DR, SPRINGFIELD, MO 65804-4320
(417) 246-2213
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2002006236
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13889142
CAQH
—
05
—
499970002
—
MO
Enumeration date
07/26/2012
Last updated
12/18/2023
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