| Doctor Name: | MS. MISTY ANN DIVIN |
| NPI Number: | 1114950482 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.P.C. |
| License Number: | 2003031288 |
| Business Practice Address: | 315 S Main Ave Bolivar, MO - 656132052 |
| Business Phone Number: | 4173262902 |
| Business Fax Number: | 4173264555 |
| Mailing Address: | 315 S Main Ave, P.o. Box 909 BOLIVAR |
| State: | MO |
| Postal Code: | 656132052 |
| Phone Number: | 4173262902 |
| Fax Number: | 4173264555 |
| NPI Enumeration Date: | 07/09/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2003031288 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |