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General NPI Number Information
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NPI Number | 1013044478
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Entity Type | Organization
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Legal Business Name | LIVING HOPE COUNSELING CENTER, PC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 535 MAINE ST SUITE 13
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City | QUINCY
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State | IL
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Zip | 62301-3950
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Country | US
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Telephone | 217-228-1887
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Fax | 217-228-1884
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Provider Business Mailing Address
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Address Line | 535 MAINE ST SUITE 13
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City | QUINCY
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State | IL
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Zip | 62301-3950
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Country | US
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Telephone | 217-228-1887
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Fax | 217-228-1884
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Authorized Official
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Title or Position | PRESIDENT & OWNER
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Name | DR. CARA RAE BAINUM
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Credential | PSY.D.
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Telephone | 217-228-1887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2006016141
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-006947
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License Number State | IL
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