Organization
FAMILY COUNSELING CENTER OF MISSOURI, INC.
Active
Other names
Boonville Outpatient Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLEN TACKER PH.D. (EXECUTIVE DIRECTOR)
(573) 443-2204
Entity
Organization
Contact information
Practice address
15899 LOGANS LAKE RD, #A, BOONVILLE, MO 65233-2866
(660) 882-2333
(660) 882-2333
Mailing address
117 N GARTH AVE, COLUMBIA, MO 65203-4103
(573) 443-2204
(573) 875-6607
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649269622
FCCMO BILLING NPI NUMBER
MO
Enumeration date
02/21/2007
Last updated
09/11/2025
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