MEDICARE: ALPHA OMEGA CHRISTIAN COUNSELING; PC

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
1	101YP2500X	Professional Counselor	IL#180.009256	IL

General Provider Information

NPI Number	:	1720478233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA OMEGA CHRISTIAN COUNSELING; PC

Provider Business Mailing Address
First Line	:	27 WINDERMERE DR
Second Line	:
City	:	GLEN CARBON
State	:	IL
Zip	:	62034-1477
Country	:	US
Telephone Number	:	618-334-6206
Fax Number	:

Provider Business Practice Location Address
First Line	:	11166 TESSON FERRY RD
Second Line	:	SUITE 203
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-6966
Country	:	US
Telephone Number	:	314-849-2120
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR OF AOCC
Name	:	DR. DAVID M. KNIGHT
Credential	:	PSYD.
Telephone Number	:	314-849-2120

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	02/04/2015

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