Regulated ProfessionsHealing ArtsChange of Address Please provide the Missouri State Board of Registration for the Healing Arts with any change in your home address. Please use the form below to report address changes, and click submit. Click here to report a change of name. You must complete the form in its entirety or no changes will be made. Name as it appears on the certificate Last Name: First Name: Middle Initial: License Number: Email: Telephone Number: (Please include area code) Effective Date: Changes dated in the future won't be changed until the date noted, and a license reflecting the new address will be mailed close to the effective date of the change. Please indicate whether you want information sent to your home or business address. Home Business Old Business Address Street: City: State: Zip Code: Old Home Address Street: City: State: Zip Code: Old Branch Address Street: City: State: Zip Code: New Business Address Street: City: State: Zip Code: Telephone Number: (Please include area code) New Home Address Street: City: State: Zip Code: Telephone Number: (Please include area code) New Branch Address Street: City: State: Zip Code: Telephone Number: (Please include area code)