Provider Demographics
NPI:1518330299
Name:LIVING WITH PURPOSE OF MISSOURI, INC.
Entity Type:Organization
Organization Name:LIVING WITH PURPOSE OF MISSOURI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KERMIT
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HARRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-896-4545
Mailing Address - Street 1:2850 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2573
Mailing Address - Country:US
Mailing Address - Phone:636-896-4545
Mailing Address - Fax:636-896-4544
Practice Address - Street 1:190 SPRING DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3255
Practice Address - Country:US
Practice Address - Phone:636-389-6756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty