Provider Demographics
NPI:1306356837
Name:GROVES, BRITTANY RACHELLE (LLC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:RACHELLE
Last Name:GROVES
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 N MARLOWE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-2857
Mailing Address - Country:US
Mailing Address - Phone:417-300-9249
Mailing Address - Fax:
Practice Address - Street 1:1531 E SUNSHINE ST STE W29
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1237
Practice Address - Country:US
Practice Address - Phone:417-300-9249
Practice Address - Fax:417-300-9249
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016044196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional