1053732305 NPI number — CATALYST COUNSELING SERVICES LLC

Table of content: TRACY YELLIN MSW, QP, LCSW (NPI 1437405024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053732305 NPI number — CATALYST COUNSELING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATALYST COUNSELING SERVICES LLC
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:
1053732305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 65
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STANBERRY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64489-0065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-392-4178
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 S STANBERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANBERRY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64489-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-392-4178
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HARKRIDER
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
816-392-4178

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , 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)





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