Provider Demographics
NPI:1407993744
Name:COUNSELING & PSYCHOLOGICAL SERVICES, UNIVERSITY OF CENTRAL MISSOURI
Entity Type:Organization
Organization Name:COUNSELING & PSYCHOLOGICAL SERVICES, UNIVERSITY OF CENTRAL MISSOURI
Other - Org Name:UNIVERSITY OF CENTRAL MISSOURI COUNSELING & PSYCHOLOGICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT DIRECTOR OF UHS FOR CPS
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DALLAS
Authorized Official - Last Name:POLYCHRONIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:660-543-4060
Mailing Address - Street 1:HUMPHREYS BLDG STE131
Mailing Address - Street 2:UNIVERSITY OF CENTRAL MISSOURI
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-5176
Mailing Address - Country:US
Mailing Address - Phone:660-543-4060
Mailing Address - Fax:660-543-8277
Practice Address - Street 1:HUMPHREYS BLDG STE131
Practice Address - Street 2:UNIVERSITY OF CENTRAL MISSOURI
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-5176
Practice Address - Country:US
Practice Address - Phone:660-543-4060
Practice Address - Fax:660-543-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01533251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10537821OtherTAX IDENTIFICATION NUMBER