Organization
BOLIVAR FAMILY COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DON AXSOM PSYD (PSYCHOLOGIST/OWNER)
(417) 399-4828
Entity
Organization
Contact information
Practice address
5438 S 244TH RD, BUFFALO, MO 65622-9373
(417) 399-4828
Mailing address
5438 S 244TH RD, BUFFALO, MO 65622-9373
(417) 399-4828
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
2003032059
MO
103T00000X
Psychologist
Primary
2006006562
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507418903
—
MO
Enumeration date
08/08/2007
Last updated
05/17/2011
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