Provider Demographics
NPI:1780965509
Name:FAMILY THERAPY OF THE OZARKS, INC
Entity type:Organization
Organization Name:FAMILY THERAPY OF THE OZARKS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:BOLING
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:417-882-7700
Mailing Address - Street 1:1310 E KINGSLEY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7216
Mailing Address - Country:US
Mailing Address - Phone:417-882-7700
Mailing Address - Fax:417-885-3956
Practice Address - Street 1:1310 E. KINGSLEY
Practice Address - Street 2:SUITE C
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7238
Practice Address - Country:US
Practice Address - Phone:417-882-7700
Practice Address - Fax:417-885-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1780965509Medicaid
MO1346412327Medicaid