1083125959 NPI number — ADVANTAGE COUNSELING ASSOCIATES LLC

Table of content: (NPI 1083125959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083125959 NPI number — ADVANTAGE COUNSELING ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANTAGE COUNSELING ASSOCIATES 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:
1083125959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7888 AUDRAIN ROAD 355
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEXICO
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65265-5816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-667-1473
Provider Business Mailing Address Fax Number:
417-944-1440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 W JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEXICO
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65265-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-567-0070
Provider Business Practice Location Address Fax Number:
417-944-1440
Provider Enumeration Date:
10/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BOBBETT
Authorized Official First Name:
TAMI
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
417-667-1473

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  2000148168 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: 001505 , 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: 001505 . This is a "LICENSED PROFESSIONAL COUNSELOR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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