Provider Demographics
NPI:1639744139
Name:STRODE, JO ELLEN BETTY (MS, PLPC, NCC)
Entity Type:Individual
Prefix:
First Name:JO ELLEN
Middle Name:BETTY
Last Name:STRODE
Suffix:
Gender:F
Credentials:MS, PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 JAKE LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-6309
Mailing Address - Country:US
Mailing Address - Phone:636-667-1459
Mailing Address - Fax:
Practice Address - Street 1:5608 N 13TH AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-6314
Practice Address - Country:US
Practice Address - Phone:417-581-6911
Practice Address - Fax:417-581-6901
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021006535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health