MEDICARE: POWERHOUSE COMMUNITY DEVELOPMENT CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP1600X	Pastoral Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1831046655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POWERHOUSE COMMUNITY DEVELOPMENT CORPORATION

Provider Business Mailing Address
First Line	:	601 W BUSINESS LOOP 70 STE 204
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2546
Country	:	US
Telephone Number	:	573-723-6030
Fax Number	:	573-723-6030

Provider Business Practice Location Address
First Line	:	601 W BUSINESS LOOP 70 STE 204
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2546
Country	:	US
Telephone Number	:	573-723-6030
Fax Number	:	573-723-6030

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHARLES L STEPHENSON
Credential	:	MAADC II
Telephone Number	:	913-549-8382

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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