Healthcare Provider Details

I. General information

NPI: 1831046655
Provider Name (Legal Business Name): POWERHOUSE COMMUNITY DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W BUSINESS LOOP 70 STE 204
COLUMBIA MO
65203-2546
US

IV. Provider business mailing address

601 W BUSINESS LOOP 70 STE 204
COLUMBIA MO
65203-2546
US

V. Phone/Fax

Practice location:
  • Phone: 573-723-6030
  • Fax: 573-723-6030
Mailing address:
  • Phone: 573-723-6030
  • Fax: 573-723-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES L STEPHENSON
Title or Position: CEO
Credential: MAADC II
Phone: 913-549-8382