Provider Demographics
NPI:1912105982
Name:OPALKA, JOHN P III (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:OPALKA
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2149 E SUNSHINE ST
Mailing Address - Street 2:APT. 202A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1816
Mailing Address - Country:US
Mailing Address - Phone:417-887-9157
Mailing Address - Fax:
Practice Address - Street 1:1525 E REPUBLIC RD STE A105
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-881-9800
Practice Address - Fax:417-882-7413
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007015360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional