Provider Demographics
NPI:1255331005
Name:SAMARITAN COUNSELING CENTER INC.
Entity Type:Organization
Organization Name:SAMARITAN COUNSELING CENTER INC.
Other - Org Name:THE CENTER, A SAMARITAN COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PADEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN MBA
Authorized Official - Phone:816-364-4300
Mailing Address - Street 1:902 EDMOND ST
Mailing Address - Street 2:STE 203
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-2702
Mailing Address - Country:US
Mailing Address - Phone:816-364-4300
Mailing Address - Fax:816-279-8148
Practice Address - Street 1:902 EDMOND ST
Practice Address - Street 2:STE 203
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-2702
Practice Address - Country:US
Practice Address - Phone:816-364-4300
Practice Address - Fax:816-279-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO011083101YP1600X
MO2001004281101YP2500X
MO01907103T00000X
MO2003024040103T00000X
MO0003631041C0700X
MOSW0003531041C0700X
207QA0401X
MOR31142084P0800X
MOR9N472084P0804X
MO076353363LP0808X
MO089198364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500323209Medicaid
C980000OtherMEDICARE PTAN
MO500323209Medicaid