NPIMap

Organization Active NPI

Youth Substance Abuse Coalition

Doing business as Epic

  • Mental Health Counselor
  • Cape Girardeau, MO
National Provider Identifier
1194452946
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
YOUTH SUBSTANCE ABUSE COALITION
Doing business as
Epic
Practice address
210 N Sprigg St
Cape Girardeau, MO 63701-5530
Phone
(573) 578-1921
NPI assigned
Aug 2, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Elizabeth Derickson, LCSWNPI 1043528052
Title
Therapist
Phone
(573) 587-1921

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

210 N Sprigg St
Cape Girardeau, MO 63701-5530

Mailing address

210 N Sprigg St
Cape Girardeau, MO 63701-5530
Phone (573) 578-1921

Other names 1

  • EPIC Doing business as

National Provider Directory

National Provider Directory

Locations

210 N Sprigg St
Cpe Girardeau, MO 63701
Phone (573) 578-1921

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659484800000",
    "number": "1194452946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 N SPRIGG ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015530",
            "telephone_number": "573-578-1921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 N SPRIGG ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015530",
            "telephone_number": "573-578-1921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH SUBSTANCE ABUSE COALITION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-02",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A",
        "authorized_official_last_name": "DERICKSON",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "573-587-1921",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EPIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EPIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cape Girardeau, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.