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General NPI Number Information
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NPI Number | 1457065294
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Entity Type | Organization
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Legal Business Name | PSYCHOSOCIAL ASSISTANCE PROGRAM INC
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 4418 W 28TH ST
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City | JOPLIN
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State | MO
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Zip | 64804-8117
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Country | US
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Telephone | 417-291-9079
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Fax |
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Provider Business Mailing Address
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Address Line | 4217 W ADOBE LN
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City | JOPLIN
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State | MO
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Zip | 64804-0186
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Country | US
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Telephone | 417-291-9079
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GERARD MONDESTIN
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Credential | LPC
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Telephone | 417-291-9079
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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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