1508237926 NPI number — FAMILY COUNSELING CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508237926 NPI number — FAMILY COUNSELING CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY COUNSELING CENTER, 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:
Provider Other Organization Name Type Code:
6
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:
1508237926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 71
Provider Second Line Business Mailing Address:
925 STATE ROUTE V V
Provider Business Mailing Address City Name:
KENNETT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63857-0071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-888-5925
Provider Business Mailing Address Fax Number:
573-888-9365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 WARRIOR LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-8685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-686-1200
Provider Business Practice Location Address Fax Number:
573-778-9492
Provider Enumeration Date:
10/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SANDO
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
SHAWN
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
573-888-5925

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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