Provider Demographics
NPI:1306388947
Name:TRINITY PROFESSIONAL COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:TRINITY PROFESSIONAL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MARISSA
Authorized Official - Last Name:TAFT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:816-425-1382
Mailing Address - Street 1:1610 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-2602
Mailing Address - Country:US
Mailing Address - Phone:816-425-1382
Mailing Address - Fax:816-343-0530
Practice Address - Street 1:1610 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-2602
Practice Address - Country:US
Practice Address - Phone:816-425-1382
Practice Address - Fax:816-343-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016013017251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health