Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Southern Light Residential

Organization Professional Counselor · NPI 1801312459

Southern Light Residential is a Professional Counselor in Bolivar, Missouri. Registered with an NPI since 2017.

In the registry since
2017

Practice location Address checks out

1211 E Broadway St
Bolivar, MO 65613-2952
Phone: (417) 850-4555
Fax: (417) 777-7017
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X

Record details

NPI number1801312459
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Cindy Drake — Admin Director · (417) 850-4555
NPI enumeratedAugust 16, 2017
Last updated in NPPESAugust 16, 2017
Mailing address707 S Pearl Ave, Joplin, MO 64801-4334

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