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515 W Cooper Maryville MO 64468-2417 | |
| (660) 562-2531 | |
| (660) 562-3239 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 515 W Cooper, Maryville, Missouri |
| Authorized Official Name and Position | Kenneth T Thom (PRESIDENT) |
| Authorized Official Contact | 6605622531 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
515 W Cooper Maryville MO 64468-2417 Ph: (660) 562-2531 | 515 W Cooper Maryville MO 64468-2417 Ph: (660) 562-2531 |
| NPI Number | 1508909938 |
|---|---|
| Provider Enumeration Date | 02/15/2007 |
| Last Update Date | 06/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508909938 | NPI | - | NPPES |
| 24206013 | Other | MO | BCBS PROVIDER |
| 1912982893 | Other | MO | NPI - PERSONAL PROVIDER |
| 10001042101 | Other | MO | COMMUNITY HEALTH PLAN PRO |
| 11633708 | Other | MO | CAHQ |
| 498635705 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 002237 (Missouri) | Primary |
| 101YP2500X | Counselor - Professional | 002237 (Missouri) | Secondary |
Hallelujah Counseling Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1315 S Main St Ste C, Maryville, MO 64468 Phone: 660-223-1700 | |
Jacobson Counseling Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 106 W Edwards St, Maryville, MO 64468 Phone: 660-254-1812 |