Healthcare Provider Details

I. General information

NPI: 1770628828
Provider Name (Legal Business Name): FAMILY COUNSELING CENTER OF MISSOURI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N 10TH ST
COLUMBIA MO
65201-4901
US

IV. Provider business mailing address

117 N GARTH AVE
COLUMBIA MO
65203-4103
US

V. Phone/Fax

Practice location:
  • Phone: 573-875-8088
  • Fax: 873-875-8089
Mailing address:
  • Phone: 573-443-2204
  • Fax: 573-875-6607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLEN TACKER
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 573-443-2204