1407993744 NPI number — COUNSELING & PSYCHOLOGICAL SERVICES, UNIVERSITY OF CENTRAL MISSOURI

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 1407993744 NPI number — COUNSELING & PSYCHOLOGICAL SERVICES, UNIVERSITY OF CENTRAL MISSOURI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING & PSYCHOLOGICAL SERVICES, UNIVERSITY OF CENTRAL MISSOURI
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:
1407993744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HUMPHREYS BLDG STE131
Provider Second Line Business Mailing Address:
UNIVERSITY OF CENTRAL MISSOURI
Provider Business Mailing Address City Name:
WARRENSBURG
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64093-5176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-543-4060
Provider Business Mailing Address Fax Number:
660-543-8277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HUMPHREYS BLDG STE131
Provider Second Line Business Practice Location Address:
UNIVERSITY OF CENTRAL MISSOURI
Provider Business Practice Location Address City Name:
WARRENSBURG
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64093-5176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-543-4060
Provider Business Practice Location Address Fax Number:
660-543-8277
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POLYCHRONIS
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
DALLAS
Authorized Official Title or Position:
ASSISTANT DIRECTOR OF UHS FOR CPS
Authorized Official Telephone Number:
660-543-4060

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  PY01533 , 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: 10537821 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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