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601 W Nifong Blvd Ste 1b Columbia MO 65203-6804 | |
| (573) 586-3204 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 601 W Nifong Blvd Ste 1b, Columbia, Missouri |
| Authorized Official Name and Position | Tara Vossenkemper (OWNER AND COUNSELOR) |
| Authorized Official Contact | 5735863204 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1055 Branch Rd Holts Summit MO 65043-1536 Ph: (314) 607-4624 | 601 W Nifong Blvd Ste 1b Columbia MO 65203-6804 Ph: (573) 586-3204 |
| NPI Number | 1093276784 |
|---|---|
| Provider Enumeration Date | 03/26/2019 |
| Last Update Date | 07/10/2024 |
| Certification Date | 07/10/2024 |
| Medicare PECOS PAC ID | 1052843273 |
|---|---|
| Medicare Enrollment ID | O20241014001189 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093276784 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Janet Alexa Robinson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699323170 PECOS PAC ID: 9638521420 Enrollment ID: I20240117002344 |
| Provider Name | Sarah Beth Gray |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982878500 PECOS PAC ID: 5597297721 Enrollment ID: I20241014001285 |
| Provider Name | Timothy Fitzpatrick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881155398 PECOS PAC ID: 1759814205 Enrollment ID: I20241023001275 |
| Provider Name | Christopher Lee |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457531923 PECOS PAC ID: 9436682820 Enrollment ID: I20241023003257 |
| Provider Name | Kacie Naros |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891366001 PECOS PAC ID: 5496288896 Enrollment ID: I20241023003957 |
| Provider Name | Sean Clouse |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902428790 PECOS PAC ID: 6901339209 Enrollment ID: I20241024003584 |
| Provider Name | Molly Jeanette Lyons-sword |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053935692 PECOS PAC ID: 1355874306 Enrollment ID: I20241029002201 |
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