Organization
TABLE ROCK COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURIE JEAN DOMSCH ACSW, LCSW (LICENSED CLINICAL SOCIAL WORKER)
(417) 272-0055
Entity
Organization
Contact information
Practice address
67 BISHOP LN, KIMBERLING CITY, MO 65686-9818
(417) 230-1279
(417) 739-1360
Mailing address
67 BISHOP LN, KIMBERLING CITY, MO 65686-9818
(417) 230-1279
(417) 739-1360
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MO 004512
MO
1041C0700X
Clinical Social Worker
MO 004512
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144201104
—
MO
Enumeration date
11/10/2005
Last updated
05/13/2016
Update your record
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