Healthcare Provider Details

I. General information

NPI: 1255331005
Provider Name (Legal Business Name): SAMARITAN COUNSELING CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 EDMOND ST STE 203
SAINT JOSEPH MO
64501-2702
US

IV. Provider business mailing address

902 EDMOND ST STE 203
SAINT JOSEPH MO
64501-2702
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-4300
  • Fax: 816-279-8148
Mailing address:
  • Phone: 816-364-4300
  • Fax: 816-279-8148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number011083
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2001004281
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01907
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2003024040
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW000353
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR3114
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberR9N47
License Number StateMO
# 9
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number076353
License Number StateMO
# 10
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number089198
License Number StateMO
# 11
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000363
License Number StateMO

VIII. Authorized Official

Name: MRS. CAROLYN S PADEN
Title or Position: EXECUTIVE DIRECTOR
Credential: RN BSN MBA
Phone: 816-364-4300