Provider Demographics
NPI:1497064547
Name:BOOTHEEL COUNSELING SERVICES
Entity Type:Organization
Organization Name:BOOTHEEL COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-0800
Mailing Address - Street 1:760 PLANTATION BLVD
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5736
Mailing Address - Country:US
Mailing Address - Phone:573-471-0800
Mailing Address - Fax:573-471-0810
Practice Address - Street 1:760 PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5736
Practice Address - Country:US
Practice Address - Phone:573-471-0800
Practice Address - Fax:573-471-0810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000013146Medicare UPIN