Provider Demographics
NPI:1710136270
Name:BAUER, MYRA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:J
Last Name:BAUER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MYRA
Other - Middle Name:J
Other - Last Name:STOVALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5349 N 22ND ST STE 5
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7627
Mailing Address - Country:US
Mailing Address - Phone:479-518-2328
Mailing Address - Fax:479-755-3782
Practice Address - Street 1:5349 N 22ND ST STE 5
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7627
Practice Address - Country:US
Practice Address - Phone:479-518-2328
Practice Address - Fax:479-755-3782
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3189-C1041C0700X
171M00000X
MO20200175051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator