1083690598 NPI number — NANCY A MAENHOUDT LCSW

Table of content: NANCY A MAENHOUDT LCSW (NPI 1083690598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083690598 NPI number — NANCY A MAENHOUDT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAENHOUDT
Provider First Name:
NANCY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRONER
Provider Other First Name:
NANCY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083690598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 COMMUNITY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64735-8804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-885-8131
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 W BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL DORADO SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64744-1133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-403-1071
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  005779 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 494638513 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".