Table Rock Counseling, Llc | |
67 Bishop Ln Kimberling City MO 65686-9818 | |
(417) 230-1279 | |
(417) 739-1360 |
Full Name | Table Rock Counseling, Llc |
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Speciality | Social Worker |
Location | 67 Bishop Ln, Kimberling City, Missouri |
Authorized Official Name and Position | Laurie Jean Domsch (LICENSED CLINICAL SOCIAL WORKER) |
Authorized Official Contact | 4172720055 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Table Rock Counseling, Llc 67 Bishop Ln Kimberling City MO 65686-9818 Ph: (417) 230-1279 | Table Rock Counseling, Llc 67 Bishop Ln Kimberling City MO 65686-9818 Ph: (417) 230-1279 |
NPI Number | 1447231808 |
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Provider Enumeration Date | 11/10/2005 |
Last Update Date | 05/13/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1447231808 | NPI | - | NPPES |
1144201104 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
104100000X | Social Worker | MO 004512 (Missouri) | Primary |
1041C0700X | Social Worker - Clinical | MO 004512 (Missouri) | Secondary |