Provider Demographics
NPI:1114235777
Name:COVENANT COUNSELING
Entity Type:Organization
Organization Name:COVENANT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:417-862-7000
Mailing Address - Street 1:227 E SUNSHINE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2652
Mailing Address - Country:US
Mailing Address - Phone:417-862-7000
Mailing Address - Fax:417-862-7007
Practice Address - Street 1:227 E SUNSHINE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2652
Practice Address - Country:US
Practice Address - Phone:417-862-7000
Practice Address - Fax:417-862-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty