Provider Demographics
NPI:1164005146
Name:COUNSELING SERVICES OF STARLA WALTON
Entity Type:Organization
Organization Name:COUNSELING SERVICES OF STARLA WALTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:417-365-6031
Mailing Address - Street 1:2947 W MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-5125
Mailing Address - Country:US
Mailing Address - Phone:417-365-6031
Mailing Address - Fax:417-512-7047
Practice Address - Street 1:601 N JEFFERSON AVE STE C
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-2798
Practice Address - Country:US
Practice Address - Phone:417-365-6031
Practice Address - Fax:417-512-7047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1447543806Medicaid