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NPI Code Detail

MEDICARE: TALEB S KHAIRALLAH MS, LPC

MEDICARE: TALEB S KHAIRALLAH MS, LPC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor2006020295MO
2101YP2500XProfessional Counselor335130-6004UT

General Provider Information

NPI Number : 1598967242
Entity Type Code : Individual
Provider Name (Legal Business Name) : TALEB S KHAIRALLAH MS, LPC
Provider Business Mailing Address
First Line : PO BOX 7687
Second Line :
City : COLUMBIA
State : MO
Zip : 65205-7687
Country : US
Telephone Number : 573-882-2259
Fax Number : 573-884-8526
Provider Business Practice Location Address
First Line : 3301 S PROVIDENCE RD BLDG E
Second Line :
City : COLUMBIA
State : MO
Zip : 65203-3624
Country : US
Telephone Number : 573-882-2511
Fax Number : 573-884-5936
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2007
Last Update Date : 10/08/2007

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