1013111798 NPI number — SUNSHINE COUNSELING, L.L.C.

Table of content: (NPI 1013111798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013111798 NPI number — SUNSHINE COUNSELING, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNSHINE COUNSELING, L.L.C.
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:
Provider Other Organization Name Type Code:
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:
1013111798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 SUCHLAND LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63379-6305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-295-0228
Provider Business Mailing Address Fax Number:
636-528-4710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 MOUND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63379-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-295-0228
Provider Business Practice Location Address Fax Number:
636-528-4710
Provider Enumeration Date:
06/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SUCHLAND
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
LUCILLE
Authorized Official Title or Position:
FOUNDER, COUNSELOR
Authorized Official Telephone Number:
636-295-0228

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  001645 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 498058106 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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