Faith Tabernacle World Outreach Inc
Organization Active NPI Emotionally Disturbed Childrens' Residential Treatment Facility · Fredericktown, MO
NPI 1417070210 · NPPES record last updated Oct 15, 2025
Key facts
- NPI
- 1417070210
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
- License
- 001742092 (MO)
- Legal business name
- FAITH TABERNACLE WORLD OUTREACH INC
- Practice address
- 600 Sargent Dr
Fredericktown, MO 63645-7526 - Phone
- (573) 783-4400
- Fax
- (573) 783-4409
- NPI assigned
- Apr 8, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Deborah Joy Booth, LPC
- Title
- Clinical Director
- Phone
- (573) 783-4400
Practitioners 17
-
Monica N Bryan, MS, PLPC
-
Angela D Lewis, LPC
-
Dorcas Unruh, MS, LPC
-
Vicki Sue Branstetter, PLPC
-
Crystal Dawn Burns, PLPC
-
Cyrena Marie Dann, MS, PLPC
-
Tina Marie Politte, LPC
-
Sherry Ann Pruett, PLPC
-
Derek Wayne Stricklin, PLPC
-
Carol Marie Thurman, PLPC
-
Lucretia Lea Whited, LPC
-
Amanda Edwards, LPC
-
Jill Elaine Jeude, LCPC
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Emotionally Disturbed Childrens' Residential Treatment Facility | 322D00000X | 001742092 | MO | Yes |
Addresses
Primary practice location
600 Sargent Dr
Fredericktown, MO 63645-7526
Mailing address
PO Box 25
Fredricktown, MO 63645
Phone (573) 783-4400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 490026705 | Medicaid | MO | |
| 495888919 | Medicaid | MO | |
| 495933814 | Medicaid | MO | |
| 495968604 | Medicaid | MO |
Other names
- Faith Foundation Children's Home
Other providers in Fredericktown, MO
- Discover Home Care
- Cindy Lee Dulaney
- Starla Kay Dulworth
- East Missouri Action Agency, Inc.
- Emily Engers
- Farmington Clinic Company LLC
- Linda Bernard Femmer
- Melinda Jo Fischer
- Christine Marie Forrest
- Christa M Forsythe
All providers in Fredericktown, MO · Emotionally Disturbed Childrens' Residential Treatment Facility in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.