Healthcare Provider Details

I. General information

NPI: 1104996750
Provider Name (Legal Business Name): ASSOCIATED COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N KINGSHIGHWAY ST IMPERIAL BUILDING
CAPE GIRARDEAU MO
63701-3506
US

IV. Provider business mailing address

PO BOX 645
CAPE GIRARDEAU MO
63702-0645
US

V. Phone/Fax

Practice location:
  • Phone: 573-335-7929
  • Fax: 573-335-6445
Mailing address:
  • Phone: 573-335-7929
  • Fax: 573-335-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY LYNN JOHNSTON
Title or Position: PRESIDENT
Credential: PH.D., LCSW, LPC
Phone: 573-335-7929