Provider Demographics
NPI:1205816089
Name:TWIN LAKES COUNSELING CENTER
Entity Type:Organization
Organization Name:TWIN LAKES COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:REMBOLT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:660-885-9100
Mailing Address - Street 1:702 E OHIO ST
Mailing Address - Street 2:PO BOX 746
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-2362
Mailing Address - Country:US
Mailing Address - Phone:660-885-9100
Mailing Address - Fax:660-885-9116
Practice Address - Street 1:702 E OHIO ST
Practice Address - Street 2:SUITE 213
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-2371
Practice Address - Country:US
Practice Address - Phone:660-885-9100
Practice Address - Fax:660-885-9116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040045921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty