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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