MEDICARE: SAMARITAN COUNSELING CENTER INC.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor	011083	MO
2	101YP2500X	Professional Counselor	2001004281	MO
3	103T00000X	Psychologist	01907	MO
4	103T00000X	Psychologist	2003024040	MO
5	1041C0700X	Clinical Social Worker	SW000353	MO
6	207QA0401X	Addiction Medicine (Family Medicine) Physician
7	2084P0800X	Psychiatry Physician	R3114	MO
8	2084P0804X	Child & Adolescent Psychiatry Physician	R9N47	MO
9	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	076353	MO
10	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	089198	MO
11	1041C0700X	Clinical Social Worker	000363	MO

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	C980000	OTHER		MEDICARE PTAN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1255331005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN COUNSELING CENTER INC.

Provider Business Mailing Address
First Line	:	902 EDMOND ST
Second Line	:	STE 203
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64501-2702
Country	:	US
Telephone Number	:	816-364-4300
Fax Number	:	816-279-8148

Provider Business Practice Location Address
First Line	:	902 EDMOND ST
Second Line	:	STE 203
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64501-2702
Country	:	US
Telephone Number	:	816-364-4300
Fax Number	:	816-279-8148

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. CAROLYN S PADEN
Credential	:	RN BSN MBA
Telephone Number	:	816-364-4300

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	05/27/2022