Provider Demographics
NPI:1356214522
Name:GREENWALT, SOPHIA D (MS, PLPC)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:D
Last Name:GREENWALT
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:AYCOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2885 W BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3952
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:
Practice Address - Street 1:3401 BERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8372
Practice Address - Country:US
Practice Address - Phone:573-777-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPENDING101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional