Healthcare Provider Details

I. General information

NPI: 1205816089
Provider Name (Legal Business Name): TWIN LAKES COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E OHIO ST SUITE 213
CLINTON MO
64735-2371
US

IV. Provider business mailing address

702 E OHIO ST PO BOX 746
CLINTON MO
64735-2362
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-9100
  • Fax: 660-885-9116
Mailing address:
  • Phone: 660-885-9100
  • Fax: 660-885-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2004004592
License Number StateMO

VIII. Authorized Official

Name: MISS TAMI ANNE REMBOLT
Title or Position: OWNER
Credential: LCSW
Phone: 660-885-9100