Healthcare Provider Details

I. General information

NPI: 1689020927
Provider Name (Legal Business Name): BOOTHEEL COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 PLANTATION BLVD
SIKESTON MO
63801-5736
US

IV. Provider business mailing address

760 PLANTATION BLVD
SIKESTON MO
63801-5736
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-0800
  • Fax: 573-471-5740
Mailing address:
  • Phone: 573-471-0800
  • Fax: 573-471-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN EVANS
Title or Position: FISCAL DIRECTOR
Credential: BA
Phone: 573-471-0800