Organization
COMMUNITY COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA TOLBERT (CHIEF OPERATING OFFICER)
(573) 334-1100
Entity
Organization
Contact information
Practice address
402 S SILVER SPRINGS RD, CAPE GIRARDEAU, MO 63703-7536
(573) 334-1100
Mailing address
402 S SILVER SPRINGS RD, CAPE GIRARDEAU, MO 63703-7536
(573) 334-1100
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
2907523
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152624011
—
MO
Enumeration date
02/16/2007
Last updated
09/17/2024
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