=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831614346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALIGNING MINDS COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2017
-----------------------------------------------------
Last Update Date | 08/04/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 122 BRADLEY DR
-----------------------------------------------------
City | SIKESTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63801-4658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-620-0639
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1681
-----------------------------------------------------
City | SIKESTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63801-1681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-620-0639
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | DORIS DENISE MCQUERTER
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 573-620-0639
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 2013023047
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------