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General NPI Number Information
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NPI Number | 1508909938
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Entity Type | Organization
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Legal Business Name | KEN THOM COUNSELING INC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 515 W COOPER
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City | MARYVILLE
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State | MO
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Zip | 64468-2417
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Country | US
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Telephone | 660-562-2531
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Fax | 660-562-3239
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Provider Business Mailing Address
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Address Line | 515 W COOPER
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City | MARYVILLE
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State | MO
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Zip | 64468-2417
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Country | US
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Telephone | 660-562-2531
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Fax | 660-562-3239
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KENNETH T THOM
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Credential | LPC
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Telephone | 660-562-2531
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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 | 002237
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 002237
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License Number State | MO
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