1508909938 NPI number — KEN THOM COUNSELING INC

Table of content: (NPI 1508909938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508909938 NPI number — KEN THOM COUNSELING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEN THOM COUNSELING 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:
1508909938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 W COOPER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64468-2417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-562-2531
Provider Business Mailing Address Fax Number:
660-562-3239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 W COOPER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64468-2417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-562-2531
Provider Business Practice Location Address Fax Number:
660-562-3239
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THOM
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
660-562-2531

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  002237 , 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: 002237 , 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: 24206013 . This is a "BCBS PROVIDER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1912982893 . This is a "NPI - PERSONAL PROVIDER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 10001042101 . This is a "COMMUNITY HEALTH PLAN PRO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 11633708 . This is a "CAHQ" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 498635705 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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