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General NPI Number Information
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NPI Number | 1891229878
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Entity Type | Organization
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Legal Business Name | BENTON STREET COUNSELING LLC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 89 MCCRORY DRIVE
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City | CAMDENTON
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State | MO
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Zip | 65020
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Country | US
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Telephone | 573-525-7071
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Fax | 573-525-7072
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Provider Business Mailing Address
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Address Line | PO BOX 856
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City | CAMDENTON
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State | MO
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Zip | 65020-0856
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Country | US
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Telephone | 573-525-7071
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Fax | 573-525-7072
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Authorized Official
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Title or Position | MEMBER
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Name | NECOLE L OLMSTEAD
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Credential | LPC
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Telephone | 573-525-7071
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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 | 2012036248
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2015043538
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2016007581
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2013023278
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2015000875
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License Number State | MO
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Taxonomy #6
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2014034465
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License Number State | MO
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Taxonomy #7
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2010030790
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License Number State | MO
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Taxonomy #8
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2010036135
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License Number State | MO
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Taxonomy #9
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2004020356
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License Number State | MO
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