Provider Demographics
NPI:1952755019
Name:NIXA BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:NIXA BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-494-5031
Mailing Address - Street 1:307 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8413
Mailing Address - Country:US
Mailing Address - Phone:417-494-5031
Mailing Address - Fax:417-551-4146
Practice Address - Street 1:307 S WEST ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8413
Practice Address - Country:US
Practice Address - Phone:417-494-5031
Practice Address - Fax:417-551-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty