Southern Light Residential

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

SOUTHERN LIGHT RESIDENTIAL

Practice address

1211 E Broadway St
Bolivar, MO 65613-2952

Phone

(417) 850-4555

Fax

(417) 777-7017

NPI assigned

Aug 16, 2017

Last updated

Aug 16, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cindy Drake

Title

Admin Director

Phone

(417) 850-4555

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1502841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502841600000",
    "number": "1801312459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 S PEARL AVE",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648014334",
            "telephone_number": "417-850-4555",
            "fax_number": "417-777-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 E BROADWAY ST",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132952",
            "telephone_number": "417-850-4555",
            "fax_number": "417-777-7017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN LIGHT RESIDENTIAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-16",
        "last_updated": "2017-08-16",
        "status": "A",
        "authorized_official_last_name": "DRAKE",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "ADMIN DIRECTOR",
        "authorized_official_telephone_number": "417-850-4555"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda K Smith
• Kenneth Ronald Smith, MD
• Lynetta S Smith, MS, RDN, LD
• Thomas James Sneed, DPT
• Southern Light Community Counseling
• Southwest Ozark Optometric Physicians Inc
• Sparks Pharmacy Inc (Bolivar Drug Compounding and Wellness)
• Sparks Pharmacy Inc (Bolivar Drug)
• Jeff Sparks
• John Richard Spooner, PSY.D.

• Professional Counselor in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2017; 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.