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General NPI Number Information
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NPI Number | 1417070210
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Entity Type | Organization
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Legal Business Name | FAITH TABERNACLE WORLD OUTREACH INC
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Dates
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Enumeration Date | 04/08/2007
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 600 SARGENT DR
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City | FREDERICKTOWN
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State | MO
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Zip | 63645-7526
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Country | US
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Telephone | 573-783-4400
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Fax | 573-783-4409
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Provider Business Mailing Address
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Address Line | PO BOX 25
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City | FREDRICKTOWN
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State | MO
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Zip | 63645
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Country | US
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Telephone | 573-783-4400
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Fax | 573-783-4409
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. DEBORAH JOY BOOTH
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Credential | LPC
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Telephone | 573-783-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 001742092
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License Number State | MO
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