Provider Demographics
NPI:1235546052
Name:TAILORED COUNSELING
Entity Type:Organization
Organization Name:TAILORED COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:PLPC
Authorized Official - Phone:816-617-6259
Mailing Address - Street 1:2915 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1016
Mailing Address - Country:US
Mailing Address - Phone:816-617-6259
Mailing Address - Fax:
Practice Address - Street 1:2915 JENNIFER LN
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB
Practice Address - State:MO
Practice Address - Zip Code:64506-1016
Practice Address - Country:US
Practice Address - Phone:816-617-6259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010041726101YP2500X
MO2013030909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty