Basic Information
| Provider Information | |||||||||
| NPI: | 1063027902 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BABILON | ||||||||
| FirstName: | SALOME | ||||||||
| MiddleName: | AVERI | ||||||||
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| Credential: | PLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3916 S COACHMAN DR | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640554040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169054136 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 105C W WALL ST | ||||||||
| Address2: | |||||||||
| City: | HARRISONVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647012355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169747378 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2020 | ||||||||
| LastUpdateDate: | 09/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2020029091 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.