Provider Demographics
NPI:1396363289
Name:MIDDLE PATH COUNSELING
Entity Type:Organization
Organization Name:MIDDLE PATH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JULSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:479-283-1652
Mailing Address - Street 1:1942 NW COPPER OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-8300
Mailing Address - Country:US
Mailing Address - Phone:479-283-1652
Mailing Address - Fax:
Practice Address - Street 1:1942 NW COPPER OAKS CIR
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-8300
Practice Address - Country:US
Practice Address - Phone:479-283-1652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1336519859OtherNPI