1538204904 NPI number — FAMILY COUNSELING CENTER OF MISSOURI, INC.

Table of content: (NPI 1538204904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538204904 NPI number — FAMILY COUNSELING CENTER OF MISSOURI, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY COUNSELING CENTER OF MISSOURI, 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:
1538204904
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:
117 N GARTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65203-4103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-443-2204
Provider Business Mailing Address Fax Number:
573-875-6607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15899 LOGANS LAKE RD
Provider Second Line Business Practice Location Address:
#A
Provider Business Practice Location Address City Name:
BOONVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65233-2866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-882-2333
Provider Business Practice Location Address Fax Number:
660-882-2333
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TACKER
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
573-443-2204

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1649269622 . This is a "FCCMO BILLING NPI NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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