Provider Demographics
NPI:1497171763
Name:SERENITY COUNSELING SERVICE
Entity Type:Organization
Organization Name:SERENITY COUNSELING SERVICE
Other - Org Name:SERENITY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:CRAADC, NCC, PLPC
Authorized Official - Phone:816-364-3154
Mailing Address - Street 1:1212 FARAON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-2310
Mailing Address - Country:US
Mailing Address - Phone:816-364-3154
Mailing Address - Fax:
Practice Address - Street 1:1212 FARAON ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-2310
Practice Address - Country:US
Practice Address - Phone:816-364-3154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013030909101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty