Provider Demographics
NPI:1194026765
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:L
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-888-5925
Mailing Address - Street 1:925 HWY V V
Mailing Address - Street 2:PO BOX 71
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 1:500 US HWY 61 NORTH
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851
Practice Address - Country:US
Practice Address - Phone:573-359-2600
Practice Address - Fax:573-359-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder