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General NPI Number Information
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NPI Number | 1720216047
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Entity Type | Organization
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Legal Business Name | CARTHAGE COUNSELING
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 06/26/2009
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Provider Practice Location Address
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Address Line | 2411 FAIRLAWN DR
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City | CARTHAGE
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State | MO
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Zip | 64836-3517
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Country | US
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Telephone | 417-359-8093
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Fax | 417-359-8094
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Provider Business Mailing Address
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Address Line | P.O BOX 54 2411 FAIRLAWN DR
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City | CARTHAGE
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State | MO
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Zip | 64836-0054
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Country | US
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Telephone | 417-359-8093
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Fax | 417-359-8094
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | ELAINE CHILDS
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Credential | LPC
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Telephone | 417-359-8093
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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 | 002532
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License Number State | MO
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