Healthcare Provider Details

I. General information

NPI: 1972611010
Provider Name (Legal Business Name): COUNSELING CONCEPTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 12TH STREET
WASHINGTON MO
63090
US

IV. Provider business mailing address

PO BOX 161
VILLA RIDGE MO
63089
US

V. Phone/Fax

Practice location:
  • Phone: 636-390-4422
  • Fax: 636-390-4449
Mailing address:
  • Phone: 636-390-4422
  • Fax: 636-390-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2000172758
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number2000172758
License Number StateMO

VIII. Authorized Official

Name: LIZABETH L WERNER
Title or Position: OWNER
Credential: LCSW
Phone: 636-390-4422