Organization Name: | TAILORED COUNSELING |
NPI Number: | 1235546052 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACKIE D MOSER (THERAPIST) |
Mailing Address: | 2915 Jennifer Ln Country Club |
State: | MO US |
Postal Code: | 645061016 |
Phone Number: | 8166176259 |
Fax Number: | |
NPI Enumeration Date: | 07/14/2014 |
NPI Last Update Date: | 07/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2010041726 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |