Provider Demographics
NPI:1720216047
Name:CARTHAGE COUNSELING
Entity Type:Organization
Organization Name:CARTHAGE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:417-359-8093
Mailing Address - Street 1:P.O BOX 54
Mailing Address - Street 2:2411 FAIRLAWN DR
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-0054
Mailing Address - Country:US
Mailing Address - Phone:417-359-8093
Mailing Address - Fax:417-359-8094
Practice Address - Street 1:2411 FAIRLAWN DR
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-3517
Practice Address - Country:US
Practice Address - Phone:417-359-8093
Practice Address - Fax:417-359-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002532101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1205915576OtherNPI
MO499805810Medicaid