| Countryside Counseling Llc | |
|
313 South Ave Ste 405 Springfield MO 65806-2255 | |
| (417) 597-4685 | |
| (855) 437-0772 |
| Full Name | Countryside Counseling Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 313 South Ave Ste 405, Springfield, Missouri |
| Authorized Official Name and Position | Joshua Edward Freeman (OWNER) |
| Authorized Official Contact | 4175974685 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Countryside Counseling Llc 3036 W Countryside Dr Springfield MO 65807-3936 Ph: (417) 597-4685 | Countryside Counseling Llc 313 South Ave Ste 405 Springfield MO 65806-2255 Ph: (417) 597-4685 |
| NPI Number | 1891381216 |
|---|---|
| Provider Enumeration Date | 12/19/2020 |
| Last Update Date | 12/30/2021 |
| Certification Date | 12/30/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891381216 | NPI | - | NPPES |
| 1245796440 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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