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Southern Light Residential
Professional Counselor in Bolivar, Missouri
NPI 1801312459

Southern Light Residential is a Professional Counselor based in Joplin, MO and is specialized in Professional. Southern Light Residential practices in Bolivar, MO. The NPI Number for Southern Light Residential is 1801312459 and holds a License No. (Missouri).

The current practice location address for Southern Light Residential is 1211 E Broadway St, Bolivar, MO and can be reached out via phone at 417-850-4555 and via fax at 417-777-7017.

Location: 1211 E Broadway St, Bolivar, MO, 64801-4334
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1801312459
Provider Name
Southern Light Residential
Credential
Provider Entity Type
Organization
Address
1211 E Broadway St, Bolivar, MO, 64801-4334
Phone Number
417-850-4555
Fax Number
417-777-7017
Provider Enumeration Date
08/16/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1211 E Broadway St
City
Bolivar
State
Missouri
Zip
65613-2952
Phone Number
417-850-4555
Fax Number
417-777-7017
person
Provider Business Mailing Address Details
Address
1211 E Broadway St
City
Bolivar
State
Missouri
Zip
65613-2952
Phone Number
417-850-4555
Fax Number
417-777-7017
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
101YP2500X
License No.
()
Definition
Definition to come...
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