Provider Demographics
NPI:1225252364
Name:SOUTHWEST MISSOURI COUNSELING
Entity Type:Organization
Organization Name:SOUTHWEST MISSOURI COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRILEY
Authorized Official - Suffix:I
Authorized Official - Credentials:MACE CSACII ICADC
Authorized Official - Phone:417-451-0624
Mailing Address - Street 1:516 W MCCORD ST
Mailing Address - Street 2:PO BOX 485
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-1424
Mailing Address - Country:US
Mailing Address - Phone:417-451-0624
Mailing Address - Fax:417-451-0875
Practice Address - Street 1:516 W MCCORD ST
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1424
Practice Address - Country:US
Practice Address - Phone:417-451-0624
Practice Address - Fax:417-451-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1305 8757251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========Medicaid