Provider Demographics
NPI:1700148160
Name:PREMIER THERAPIES, LLC
Entity Type:Organization
Organization Name:PREMIER THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LA MAR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-443-4038
Mailing Address - Street 1:16471 S HAWKINS RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-9328
Mailing Address - Country:US
Mailing Address - Phone:573-443-4038
Mailing Address - Fax:573-657-1125
Practice Address - Street 1:1005 CHERRY ST
Practice Address - Street 2:SUITE 202B
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7900
Practice Address - Country:US
Practice Address - Phone:573-443-4038
Practice Address - Fax:573-657-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000750101YM0800X
MO000723101YM0800X
MO2004024724103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty