Provider Demographics
NPI:1205206786
Name:LUTHERAN FAMILY & CHILDREN SERVICES - MID MO OFFICE
Entity Type:Organization
Organization Name:LUTHERAN FAMILY & CHILDREN SERVICES - MID MO OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALL-WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CRADC
Authorized Official - Phone:573-815-9955
Mailing Address - Street 1:307 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:307 LOCUST ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4203
Practice Address - Country:US
Practice Address - Phone:573-815-9955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty