Healthcare Provider Details

I. General information

NPI: 1154935112
Provider Name (Legal Business Name): OVERCOMERS COUNSELING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2020
Last Update Date: 09/06/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17101 EAST 203RD ST
PECULIAR MO
64078
US

IV. Provider business mailing address

941 SELBY CT
RAYMORE MO
64083
US

V. Phone/Fax

Practice location:
  • Phone: 816-255-5375
  • Fax:
Mailing address:
  • Phone: 816-255-6375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LUCINDA GRACE PENNINGTON
Title or Position: OWNER/COUNSELOR
Credential: MS/MA
Phone: 816-255-5375