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General NPI Number Information
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NPI Number | 1164005146
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Entity Type | Organization
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Legal Business Name | COUNSELING SERVICES OF STARLA WALTON
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 601 N JEFFERSON AVE STE C
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City | LEBANON
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State | MO
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Zip | 65536-2798
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Country | US
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Telephone | 417-365-6031
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Fax | 417-512-7047
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Provider Business Mailing Address
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Address Line | 2947 W MOUNT VERNON ST
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City | SPRINGFIELD
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State | MO
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Zip | 65802-5125
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Country | US
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Telephone | 417-365-6031
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Fax | 417-512-7047
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STARLA B WALTON
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Credential | MS, LPC
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Telephone | 417-365-6031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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