Provider Demographics
NPI:1336393669
Name:PRAISE ASSEMBY
Entity Type:Organization
Organization Name:PRAISE ASSEMBY
Other - Org Name:SAFE ARBOR COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:417-833-8300
Mailing Address - Street 1:4010 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-5756
Mailing Address - Country:US
Mailing Address - Phone:417-619-8921
Mailing Address - Fax:
Practice Address - Street 1:2032 E KEARNEY ST STE 214
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4662
Practice Address - Country:US
Practice Address - Phone:417-833-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008032814251S00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health