Provider Demographics
NPI:1740582956
Name:CENTER FOR COUNSELING & TRAINING LLC
Entity Type:Organization
Organization Name:CENTER FOR COUNSELING & TRAINING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTSON ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:660-259-3900
Mailing Address - Street 1:2555 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1951
Mailing Address - Country:US
Mailing Address - Phone:660-259-3900
Mailing Address - Fax:660-259-9127
Practice Address - Street 1:2555 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1951
Practice Address - Country:US
Practice Address - Phone:660-259-3900
Practice Address - Fax:660-259-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002655101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495043424Medicaid