Provider Demographics
NPI:1790255784
Name:RE-ENTRY TRANSITIONS COUNSELING, L.L.C.
Entity Type:Organization
Organization Name:RE-ENTRY TRANSITIONS COUNSELING, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:MADDOX
Authorized Official - Last Name:LAURIE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LCSW
Authorized Official - Phone:573-246-6000
Mailing Address - Street 1:500 MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2808
Mailing Address - Country:US
Mailing Address - Phone:573-246-6000
Mailing Address - Fax:
Practice Address - Street 1:500 MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2808
Practice Address - Country:US
Practice Address - Phone:573-246-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty