Organization
SHARE
Active
Organization
SHARE
Active
Other names
Dancing Horizon Family Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN W LOUDERBACK HHP CHT PSYD (MANAGER)
(417) 429-2180
Entity
Organization
Contact information
Practice address
514 N WEST BYPASS, SPRINGFIELD, MO 65802
(417) 429-2180
(417) 832-9799
Mailing address
514 N WEST BYPASS, SPRINGFIELD, MO 65802
(417) 429-2180
(417) 832-9799
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
175F00000X
Naturopath
—
—
207Q00000X
Family Medicine Physician
RIF83
MO
208D00000X
General Practice Physician
R1200
MO
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501465009
—
MO
Enumeration date
05/29/2007
Last updated
02/05/2009
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