Healthcare Provider Details

I. General information

NPI: 1366232761
Provider Name (Legal Business Name): SEMO FAMILY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E JACKSON BLVD
JACKSON MO
63755-2434
US

IV. Provider business mailing address

902 E JACKSON BLVD
JACKSON MO
63755-2434
US

V. Phone/Fax

Practice location:
  • Phone: 573-332-7992
  • Fax:
Mailing address:
  • Phone: 573-979-1085
  • Fax: 573-332-7998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JEDEDIAH WEBSTER
Title or Position: OWNER
Credential:
Phone: 573-332-7992