Provider Demographics
NPI:1699836403
Name:SOLID ROCK CHRISTIAN COUNSELING, INC
Entity Type:Organization
Organization Name:SOLID ROCK CHRISTIAN COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-785-0333
Mailing Address - Street 1:2725 N WESTWOOD BLVD
Mailing Address - Street 2:STE.5A
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2346
Mailing Address - Country:US
Mailing Address - Phone:573-785-0333
Mailing Address - Fax:573-785-0333
Practice Address - Street 1:2725 N WESTWOOD BLVD
Practice Address - Street 2:STE.5A
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2346
Practice Address - Country:US
Practice Address - Phone:573-785-0333
Practice Address - Fax:573-785-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1699836403OtherVALUE OPTIONS
MO1699836403OtherHEALTHLINK, INC
MO1699836403Medicaid
MO1699836403OtherMEDICARE CMS
MO1699836403OtherANTHEM BLUE CROSS BLUE SHIELD
MO1699836403OtherUNITED HEALTHCARE