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General NPI Number Information
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NPI Number | 1568985075
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Entity Type | Organization
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Legal Business Name | FATINO COUNSELING, LLC
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/18/2017
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Provider Practice Location Address
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Address Line | 1901 WOMMACK AVE
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City | BOLIVAR
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State | MO
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Zip | 65613-3128
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Country | US
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Telephone | 417-766-8090
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Fax | 417-777-7017
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Provider Business Mailing Address
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Address Line | PO BOX 967
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City | BOLIVAR
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State | MO
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Zip | 65613-0967
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CINDY DRAKE
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Credential |
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Telephone | 417-766-8090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2274
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License Number State | MO
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