Organization Name: | BERTHELOT COUNSELING |
NPI Number: | 1154541746 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WILSON BERTHELOT (OFFICE MANAGER) |
Mailing Address: | 212 S Walnut St Dexter |
State: | MO US |
Postal Code: | 638412144 |
Phone Number: | 5736249383 |
Fax Number: | |
NPI Enumeration Date: | 04/26/2007 |
NPI Last Update Date: | 06/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 001694 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |