Basic Information
| Provider Information | |||||||||
| NPI: | 1942333562 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOOTHEEL COUNSELING SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 760 PLANTATION BLVD | ||||||||
| Address2: | |||||||||
| City: | SIKESTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638015736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734710800 | ||||||||
| FaxNumber: | 5734710810 | ||||||||
| Practice Location | |||||||||
| Address1: | 760 PLANTATION BLVD | ||||||||
| Address2: | |||||||||
| City: | SIKESTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638015736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734710800 | ||||||||
| FaxNumber: | 5734710810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXCUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5734710800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | 274-8045 | MO | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.