Provider Demographics
NPI:1043554934
Name:STAPLES, ERIC JOSEPH (LPC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOSEPH
Last Name:STAPLES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SOUTH SUNSHINE ST.
Mailing Address - Street 2:FIRST BAPTIST CHURCH-BRANSON
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-2518
Mailing Address - Country:US
Mailing Address - Phone:417-334-7437
Mailing Address - Fax:417-335-2273
Practice Address - Street 1:400 S SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2518
Practice Address - Country:US
Practice Address - Phone:417-334-7437
Practice Address - Fax:417-335-2273
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013004224101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral