Provider Demographics
NPI:1023197274
Name:FAMILY INSTITUTE OF THE OZARKS
Entity Type:Organization
Organization Name:FAMILY INSTITUTE OF THE OZARKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:N
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:417-326-2902
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-0909
Mailing Address - Country:US
Mailing Address - Phone:417-326-2902
Mailing Address - Fax:417-326-4555
Practice Address - Street 1:315 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2052
Practice Address - Country:US
Practice Address - Phone:417-326-2902
Practice Address - Fax:417-326-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003031288101YP2500X
MO2004037100101YP2500X
MO2002023735101YP2500X
MO00749103T00000X
MO01577103T00000X
MO01731103T00000X
MO2002030479103T00000X
MO2002004681103T00000X
MO0047581041C0700X
MO2000172760106H00000X
MO300020106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty