Provider Demographics
NPI:1710698402
Name:INSIGHT DYNAMICS LLC
Entity Type:Organization
Organization Name:INSIGHT DYNAMICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANEISA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHERRILL-MATTOX
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:660-882-6400
Mailing Address - Street 1:413 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1573
Mailing Address - Country:US
Mailing Address - Phone:166-088-2640
Mailing Address - Fax:
Practice Address - Street 1:413 E SPRING ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1573
Practice Address - Country:US
Practice Address - Phone:166-088-2640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490078150Medicaid