Healthcare Provider Details

I. General information

NPI: 1083125959
Provider Name (Legal Business Name): ADVANTAGE COUNSELING ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W JACKSON ST
MEXICO MO
65265-2712
US

IV. Provider business mailing address

7888 AUDRAIN ROAD 355
MEXICO MO
65265-5816
US

V. Phone/Fax

Practice location:
  • Phone: 573-567-0070
  • Fax: 417-944-1440
Mailing address:
  • Phone: 417-667-1473
  • Fax: 417-944-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number001505
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2000148168
License Number StateMO

VIII. Authorized Official

Name: TAMI BOBBETT
Title or Position: OFFICE MANAGER
Credential:
Phone: 417-667-1473