1104658129 NPI number — NEW ERA COUNSELING SERVICES LLP

Table of content: MR. WILMER CONRAD BETTS III FNP (NPI 1275674707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104658129 NPI number — NEW ERA COUNSELING SERVICES LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ERA COUNSELING SERVICES LLP
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:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1104658129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
810 SE 144TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEWARTSVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64490-8502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-306-6515
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9896 SW WILLARD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEWARTSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64490-6110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-387-3744
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2024

Additional Information

Authorized Official

Authorized Official Last Name:
LUEDTKE
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
816-306-6515

Provider Taxonomy Codes

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

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





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