Provider Demographics
NPI:1245890086
Name:KLUSMEYER, MALEA A (MS, PLPC)
Entity type:Individual
Prefix:
First Name:MALEA
Middle Name:A
Last Name:KLUSMEYER
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:MALEA
Other - Middle Name:A
Other - Last Name:MERCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2141 E CLAIBORNE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3821
Mailing Address - Country:US
Mailing Address - Phone:417-599-9945
Mailing Address - Fax:
Practice Address - Street 1:2025 E CHESTNUT EXPY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2222
Practice Address - Country:US
Practice Address - Phone:417-848-1756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000Medicaid