Lifewell Mind and Body Clinic

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

LIFEWELL MIND AND BODY CLINIC

Practice address

12318 State Rte E
West Plains, MO 65775-7530

Phone

(417) 257-4999

NPI assigned

Oct 10, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Myriah Wallace, LPCNPI 1184921496

Title

Owner

Phone

(417) 257-4999

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Myriah Dawn Wallace, LPC

  • Professional Counselor
  • West Plains, MO
  • NPI 1184921496

  Counselor

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1760054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760054400000",
    "number": "1184590853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12318 STATE RTE E",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657757530",
            "telephone_number": "417-257-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12318 STATE RTE E",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657757530",
            "telephone_number": "417-257-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEWELL MIND AND BODY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-10",
        "last_updated": "2025-10-10",
        "certification_date": "2025-10-10",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "MYRIAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-257-4999",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jaime E Lile, COTA
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• Barbara Linville, OTR/L
• David Blake Lish, DPM
• Deborah Lockerby

• All providers in West Plains, MO
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.