Provider Demographics
NPI:1851088942
Name:CAYWOOD, COURTNEY A (PLPC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:A
Last Name:CAYWOOD
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ANN
Other - Last Name:ZIND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLPC
Mailing Address - Street 1:7490 E FARM ROAD 156
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-8858
Mailing Address - Country:US
Mailing Address - Phone:417-554-0829
Mailing Address - Fax:
Practice Address - Street 1:5425 S FERGUSON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2580
Practice Address - Country:US
Practice Address - Phone:417-773-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023039614101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490135506Medicaid