=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427341510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLID ROCK CHRISTIAN COUNSELING, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2011
-----------------------------------------------------
Last Update Date | 05/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2725 N WESTWOOD BLVD SUITE 5A
-----------------------------------------------------
City | POPLAR BLUFF
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63901-2346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-785-0333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2725 N WESTWOOD BLVD SUITE 5A
-----------------------------------------------------
City | POPLAR BLUFF
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63901-2346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-785-0333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. MELISSA M ALLEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 573-785-0333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 2011012790
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------