Provider Demographics
NPI:1770662199
Name:CENTER FOR COUNSELING AND PASTORAL CARE
Entity Type:Organization
Organization Name:CENTER FOR COUNSELING AND PASTORAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV, MSW
Authorized Official - Phone:636-527-7615
Mailing Address - Street 1:7680 LINDBERGH DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2138
Mailing Address - Country:US
Mailing Address - Phone:636-527-7615
Mailing Address - Fax:636-527-7635
Practice Address - Street 1:7680 LINDBERGH DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-2138
Practice Address - Country:US
Practice Address - Phone:636-527-7615
Practice Address - Fax:636-527-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-05
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004029338101YP1600X, 1041C0700X
IL180-000873101YP2500X
IL180-002690101YP2500X
IL101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty