1104996750 NPI number — ASSOCIATED COUNSELING SERVICES, INC.

Table of content: (NPI 1104996750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104996750 NPI number — ASSOCIATED COUNSELING SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED COUNSELING SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ASSOCIATED COUNSELING SERVICES
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104996750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 645
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE GIRARDEAU
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63702-0645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-335-7929
Provider Business Mailing Address Fax Number:
573-335-6445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 N KINGSHIGHWAY ST
Provider Second Line Business Practice Location Address:
IMPERIAL BUILDING
Provider Business Practice Location Address City Name:
CAPE GIRARDEAU
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63701-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-335-7929
Provider Business Practice Location Address Fax Number:
573-335-6445
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSTON
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
573-335-7929

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 759297 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".




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