Provider Demographics
NPI:1770325714
Name:GREATHOUSE, STORMY D (LMSW)
Entity type:Individual
Prefix:
First Name:STORMY
Middle Name:D
Last Name:GREATHOUSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 FAIR RD
Mailing Address - Street 2:
Mailing Address - City:GOODMAN
Mailing Address - State:MO
Mailing Address - Zip Code:64843-6000
Mailing Address - Country:US
Mailing Address - Phone:417-389-6325
Mailing Address - Fax:
Practice Address - Street 1:530 S MAIDEN LN
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-3084
Practice Address - Country:US
Practice Address - Phone:417-782-6200
Practice Address - Fax:417-782-6210
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023045725101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor