Provider Demographics
NPI:1235296237
Name:FAMILY COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:FAMILY COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSA
Authorized Official - Phone:573-888-5925
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-0071
Mailing Address - Country:US
Mailing Address - Phone:573-888-5925
Mailing Address - Fax:573-888-9365
Practice Address - Street 1:925 HWY V V
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857
Practice Address - Country:US
Practice Address - Phone:573-888-5925
Practice Address - Fax:573-888-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500075106Medicaid