Healthcare Provider Details

I. General information

NPI: 1508909938
Provider Name (Legal Business Name): KEN THOM COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W COOPER
MARYVILLE MO
64468-2417
US

IV. Provider business mailing address

515 W COOPER
MARYVILLE MO
64468-2417
US

V. Phone/Fax

Practice location:
  • Phone: 660-562-2531
  • Fax: 660-562-3239
Mailing address:
  • Phone: 660-562-2531
  • Fax: 660-562-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number002237
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002237
License Number StateMO

VIII. Authorized Official

Name: MR. KENNETH T THOM
Title or Position: PRESIDENT
Credential: LPC
Phone: 660-562-2531