Provider Demographics
NPI:1497347140
Name:SPROUS, LISA A (PLPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:SPROUS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2885 W BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3952
Mailing Address - Country:US
Mailing Address - Phone:417-761-5214
Mailing Address - Fax:
Practice Address - Street 1:18593 BUSINESS 13 STE 104106
Practice Address - Street 2:
Practice Address - City:BRANSON WEST
Practice Address - State:MO
Practice Address - Zip Code:65737-9659
Practice Address - Country:US
Practice Address - Phone:417-761-5271
Practice Address - Fax:417-272-3022
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210409551041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical