Active NPI
Neal Evan Desha, MED, LPC
- Professional Counselor
- Springfield, MO
National Provider Identifier
1063979474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2004014921
- Practice address
- 440 S Market Ave
Springfield, MO 65806-2026 - Phone
- (573) 821-3513
- NPI assigned
- Feb 22, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2004014921 | MO | Primary |
Addresses
Primary practice location
440 S Market Ave
Springfield, MO 65806-2026
Mailing address
1624 S Raford Dr
Springfield, MO 65809-2336
Phone (573) 821-3513
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14407460 | Other | MO | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004014921 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660780800000",
"number": "1063979474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1624 S RAFORD DR",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658092336",
"telephone_number": "573-821-3513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 S MARKET AVE",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658062026",
"telephone_number": "573-821-3513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESHA",
"first_name": "NEAL",
"middle_name": "EVAN",
"credential": "MED, LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-22",
"last_updated": "2022-08-18",
"certification_date": "2022-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2004014921",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "14407460",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.