Provider Demographics
NPI:1437801925
Name:TOMLINSON, GRACE EMILY (LCSW)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:EMILY
Last Name:TOMLINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 E VALLEY WATER MILL RD APT D305
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4731
Mailing Address - Country:US
Mailing Address - Phone:417-399-3644
Mailing Address - Fax:
Practice Address - Street 1:302 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1931
Practice Address - Country:US
Practice Address - Phone:417-619-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140313731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty