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General NPI Number Information
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NPI Number | 1235546052
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Entity Type | Organization
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Legal Business Name | TAILORED COUNSELING
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 2915 JENNIFER LN
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City | COUNTRY CLUB
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State | MO
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Zip | 64506-1016
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Country | US
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Telephone | 816-617-6259
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Fax |
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Provider Business Mailing Address
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Address Line | 2915 JENNIFER LN
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City | COUNTRY CLUB
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State | MO
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Zip | 64506-1016
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Country | US
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Telephone | 816-617-6259
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | JACKIE D MOSER
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Credential | PLPC
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Telephone | 816-617-6259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2010041726
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2013030909
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License Number State | MO
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