Provider Demographics
NPI:1053688788
Name:MISSOURI PROBATION SUPERVISION SERVICES, INC.
Entity Type:Organization
Organization Name:MISSOURI PROBATION SUPERVISION SERVICES, INC.
Other - Org Name:ASSESSMENT, COUNSELING AND ENRICHMENT SERVICES, (ACES)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ADAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-403-1570
Mailing Address - Street 1:2566 LUCAS AND HUNT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-5017
Mailing Address - Country:US
Mailing Address - Phone:314-403-1570
Mailing Address - Fax:
Practice Address - Street 1:2566 LUCAS AND HUNT RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-5017
Practice Address - Country:US
Practice Address - Phone:314-403-1570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health