1851817282 NPI number — KAITLYN MCCOWELL LMSW

Table of content: KAITLYN MCCOWELL LMSW (NPI 1851817282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851817282 NPI number — KAITLYN MCCOWELL LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOWELL
Provider First Name:
KAITLYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851817282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIERCE CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65723-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-476-1000
Provider Business Mailing Address Fax Number:
417-476-1082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 N CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONETT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65708-0100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-476-1000
Provider Business Practice Location Address Fax Number:
417-236-0340
Provider Enumeration Date:
08/17/2017

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: 101YA0400X , with the licence number:  2016043586 , 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: 2016043586 . This is a "LMSW" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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