Provider Demographics
NPI:1255635660
Name:ADSERVIOR MEDIATION SERVICES, LLC
Entity type:Organization
Organization Name:ADSERVIOR MEDIATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR, PASTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:CLARENCE
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:III
Authorized Official - Credentials:PTHD/CMC
Authorized Official - Phone:816-737-1538
Mailing Address - Street 1:PO BOX 9471
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-0271
Mailing Address - Country:US
Mailing Address - Phone:816-737-1538
Mailing Address - Fax:
Practice Address - Street 1:6220 BLUE RIDGE CUTOFF
Practice Address - Street 2:STE. 204
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-3700
Practice Address - Country:US
Practice Address - Phone:816-737-1538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty