NORTHWOODS PSYCHIATRIC SERVICES INC NPI 1417902305

NPI Information

NPI: 1417902305
Provider Name: NORTHWOODS PSYCHIATRIC SERVICES INC

Doing Business As: POMME DE TERRE WELLNESS CLINIC

Classification: Clinic/Center - 261QM0850X
Entity Type: Organization

Specialization: Adult Mental Health

Address:
1100 S SPRINGFIELD AVE STE B
BOLIVAR, MO
ZIP 65613
Phone: (417) 326-7272
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NORTHWOODS PSYCHIATRIC SERVICES INC is an adult mental health clinic center in Bolivar, MO. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. NORTHWOODS PSYCHIATRIC SERVICES INC NPI is 1417902305. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Pomme De Terre Wellness Clinic.

The provider's business location address is:

1100 S SPRINGFIELD AVE STE B
BOLIVAR, MO
ZIP 65613-512
Phone: (417) 326-7272
Fax: (417) 326-2193

The provider's authorized official is Denese Strange .
The authorized official title is Office Manager and has the following contact phone number (417) 326-7272.

The enumeration date for this NPI number is 5/23/2006 and was last updated on 6/3/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	066643	MISSOURI	No
2	101YP2500X	Counselor	Professional	2004008720	MISSOURI	No
3	101YP2500X	Counselor	Professional	2003024990	MISSOURI	No
4	103TC0700X	Psychologist	Clinical	PY01322	MISSOURI	No
5	1041C0700X	Social Worker	Clinical	2004015488	MISSOURI	No
6	207Q00000X	Family Medicine		2006004145	MISSOURI	No
7	2084P0800X	Psychiatry & Neurology	Psychiatry	R1J41	MISSOURI	No
8	261QM0850X	Clinic/Center	Adult Mental Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	597191808	MEDICAID	MISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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