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Organization
EAGLE CREST COUNSELING CENTER, INC.
Active
Organization
EAGLE CREST COUNSELING CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIM W. CHERRY (OFFICE MANAGER)
(417) 862-8282
Entity
Organization
Contact information
Practice address
636 W REPUBLIC RD STE F100, SPRINGFIELD, MO 65807-5810
(417) 862-8282
(417) 862-8805
Mailing address
636 W REPUBLIC RD STE G100, SPRINGFIELD, MO 65807-5811
(417) 862-8282
(417) 862-8805
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500792502
—
MO
Enumeration date
01/11/2007
Last updated
03/01/2022
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