Organization
BENTON STREET COUNSELING LLC
Active
Parent organization
BENTON STREET COUNSELING LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BENTON STREET COUNSELING LLC
Authorized official
NECOLE L OLMSTEAD LPC (MEMBER)
(573) 525-7071
Entity
Organization
Contact information
Practice address
89 MCCRORY DRIVE, CAMDENTON, MO 65020
(573) 525-7071
(573) 525-7072
Mailing address
PO BOX 856, CAMDENTON, MO 65020-0856
(573) 525-7071
(573) 525-7072
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2004020356
MO
101YP2500X
Professional Counselor
2012036248
MO
101YP2500X
Professional Counselor
2013023278
MO
101YP2500X
Professional Counselor
2014034465
MO
101YP2500X
Professional Counselor
2015000875
MO
101YP2500X
Professional Counselor
2015043538
MO
101YP2500X
Professional Counselor
2016007581
MO
103T00000X
Psychologist
2010030790
MO
1041C0700X
Clinical Social Worker
2010036135
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932597721
—
MO
Enumeration date
04/17/2017
Last updated
04/17/2017
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