Provider Demographics
NPI: | 1629165931 |
---|---|
Name: | COUNSELING AND PSYCHOLOGICAL SERVICES LLC |
Entity type: | Organization |
Organization Name: | COUNSELING AND PSYCHOLOGICAL SERVICES LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | HARRISON |
Authorized Official - Last Name: | STRAUB |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | EDD |
Authorized Official - Phone: | 573-446-5034 |
Mailing Address - Street 1: | 2804 FORUM BLVD |
Mailing Address - Street 2: | SUITE 4 |
Mailing Address - City: | COLUMBIA |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 65203 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 573-446-5034 |
Mailing Address - Fax: | 573-446-5046 |
Practice Address - Street 1: | 2804 FORUM BLVD |
Practice Address - Street 2: | SUITE 4 |
Practice Address - City: | COLUMBIA |
Practice Address - State: | MO |
Practice Address - Zip Code: | 65203 |
Practice Address - Country: | US |
Practice Address - Phone: | 573-446-5034 |
Practice Address - Fax: | 573-446-5046 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-10-06 |
Last Update Date: | 2015-05-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty |