Organization
FAMILY COUNSELING CENTER OF MISSOURI, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALLAN TACKER (DIRECTOR OF OPERATIONS)
(573) 443-2204
Entity
Organization
Contact information
Practice address
117 N GARTH AVE, COLUMBIA, MO 65203-4103
(573) 443-2204
(573) 875-5851
Mailing address
117 N GARTH AVE, COLUMBIA, MO 65203-4103
(573) 443-2204
(573) 875-5851
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11111
CRJC GENERAL POPULATION CONTRACT
MO
Enumeration date
03/12/2010
Last updated
03/12/2010
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