Provider Demographics
NPI:1669803540
Name:CENTER FOR RELATIONSHIP RECOVERY AND COUNSELING
Entity type:Organization
Organization Name:CENTER FOR RELATIONSHIP RECOVERY AND COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:573-271-2008
Mailing Address - Street 1:3037 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2602
Mailing Address - Country:US
Mailing Address - Phone:573-271-2008
Mailing Address - Fax:573-240-9737
Practice Address - Street 1:3037 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2602
Practice Address - Country:US
Practice Address - Phone:573-271-2008
Practice Address - Fax:573-240-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009023490101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty