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Contact Information

NICOLE COSTELLO, MS.PSY,CRADC,MOUD,CS
2919 E 4TH ST
CORPORATE HOME BASE ASSIGNMENT
JOPLIN, MO64801-1625
 Phone: 417-782-7966
 Fax: 417-624-4558
 Website:
Indicates primary specialty

NPI Profile & details for

NPI Number 1013526318
Entity Organization
Organization subpart 1 Not specified
Enumeration date 07/23/2020
Last updated 01/07/2026 - About 5 months ago
Identifiers
MO License # 14770
MO License # 1922
OR License # 93-6002307
OR Medicaid 122994
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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