Provider Demographics
NPI:1700053972
Name:PROFESSIONAL COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:417-753-3389
Mailing Address - Street 1:7753 E FARM ROAD 148
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-8361
Mailing Address - Country:US
Mailing Address - Phone:417-753-3389
Mailing Address - Fax:417-753-9432
Practice Address - Street 1:7753 E FARM ROAD 148
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-8361
Practice Address - Country:US
Practice Address - Phone:417-753-3389
Practice Address - Fax:417-753-9432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000155308251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494996309Medicaid