Provider Demographics
NPI:1881966828
Name:ONE ACCORD COUNSELING LLC
Entity type:Organization
Organization Name:ONE ACCORD COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:STATLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-450-8949
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-0027
Mailing Address - Country:US
Mailing Address - Phone:573-450-8949
Mailing Address - Fax:314-884-4312
Practice Address - Street 1:1200 N KINGSHIGHWAY ST STE 4
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-3507
Practice Address - Country:US
Practice Address - Phone:573-450-8949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty