Basic Information
| Provider Information | |||||||||
| NPI: | 1750727640 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY COUNSELING CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 HIGHWAY V V | ||||||||
| Address2: | PO BOX 71 | ||||||||
| City: | KENNETT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638570071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738885925 | ||||||||
| FaxNumber: | 5738889365 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 US HWY 61 NORTH | ||||||||
| Address2: | |||||||||
| City: | HAYTI | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733590955 | ||||||||
| FaxNumber: | 5733590995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2013 | ||||||||
| LastUpdateDate: | 05/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | CALLAHAN | ||||||||
| AuthorizedOfficialFirstName: | MYRA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5738885925 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FAMILY COUNSELING CENER, INC. | ||||||||
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| AuthorizedOfficialCredential: | MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | MO | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.