Basic Information
| Provider Information | |||||||||
| NPI: | 1255841599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTON | ||||||||
| FirstName: | LANELL RENEE | ||||||||
| MiddleName: | AMANDA | ||||||||
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| Credential: | LCSW, MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 313 N MCMILLAN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN GROVE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657111522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173490673 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 353 E 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726534423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707015141 | ||||||||
| FaxNumber: | 8707015177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2017 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 10095C | AR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 2020008097 | MO | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.