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Organization
STATE OF MISSOURI
Active
Organization
STATE OF MISSOURI
Active
Parent organization
STATE OF MISSOURI
Other names
CSTAR
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF MISSOURI
Authorized official
MOLLY JANE BOECKMANN (DIRECTOR OF ADMINISTRATIVE SERVICES)
(573) 751-4055
Entity
Organization
Contact information
Practice address
1706 E ELM ST, JEFFERSON CITY, MO 65101-4130
(573) 751-3398
Mailing address
PO BOX 687, 1706 E ELM ST, JEFFERSON CITY, MO 65102-0687
(573) 751-3398
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/12/2020
Last updated
10/20/2020
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