Healthcare Provider Details

I. General information

NPI: 1912141789
Provider Name (Legal Business Name): MCGUIRE CHRISTIAN COUNSELING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 S KIMBROUGH AVE SUITE C
SPRINGFIELD MO
65807-5011
US

IV. Provider business mailing address

3101-C S KIMBROUGH AVE
SPRINGFIELD MO
65807-5011
US

V. Phone/Fax

Practice location:
  • Phone: 417-866-7773
  • Fax: 417-866-7792
Mailing address:
  • Phone: 417-866-7773
  • Fax: 417-866-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2004035843
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. AARON KEITH MCGUIRE
Title or Position: PRESIDENT
Credential: MS, LPC
Phone: 417-866-7773