Provider Demographics
NPI:1417583360
Name:PROFESSIONAL COUNSELING CONNECTIONS
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELING CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-323-8592
Mailing Address - Street 1:3021 HIGHWAY A STE 104
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-5498
Mailing Address - Country:US
Mailing Address - Phone:314-323-8592
Mailing Address - Fax:
Practice Address - Street 1:3021 HIGHWAY A STE 104
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-5498
Practice Address - Country:US
Practice Address - Phone:314-323-8592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-22
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health