Provider Demographics
NPI:1013044478
Name:LIVING HOPE COUNSELING CENTER, PC
Entity Type:Organization
Organization Name:LIVING HOPE COUNSELING CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BAINUM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:217-228-1887
Mailing Address - Street 1:535 MAINE ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3950
Mailing Address - Country:US
Mailing Address - Phone:217-228-1887
Mailing Address - Fax:217-228-1884
Practice Address - Street 1:535 MAINE ST
Practice Address - Street 2:SUITE 13
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3950
Practice Address - Country:US
Practice Address - Phone:217-228-1887
Practice Address - Fax:217-228-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006016141103T00000X
IL071-006947103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427042076OtherINDIVIDUAL NPI #
MO491638904Medicaid
MO000015205Medicare PIN
MO000015206Medicare PIN
MO491638904Medicaid