Organization
BETHANY CHRISTIAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA NICHOLSON MA, LPC (MISSOURI BRANCH DIRECTOR)
(314) 781-6363
Entity
Organization
Contact information
Practice address
210 E WASHINGTON ST, JACKSON, MO 63755-1448
(573) 204-8800
(573) 204-8833
Mailing address
PO BOX 207, JACKSON, MO 63755-0207
(573) 204-8800
(573) 204-8833
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
001523
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780777250
—
MO
Enumeration date
08/06/2008
Last updated
08/06/2008
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