Provider Demographics
NPI:1295451805
Name:CHESED COUNSELING AND COACHING CENTER, LLC
Entity type:Organization
Organization Name:CHESED COUNSELING AND COACHING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SEATON-BACON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:573-315-5156
Mailing Address - Street 1:PO BOX 585
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-0585
Mailing Address - Country:US
Mailing Address - Phone:573-315-5156
Mailing Address - Fax:
Practice Address - Street 1:612 E HIGH ST STE 210
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1426
Practice Address - Country:US
Practice Address - Phone:573-315-5156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty