NPIMap

Organization Active NPI

Community Counseling Services of Missouri, L.L.C.

  • Professional Counselor
  • Licking, MO
National Provider Identifier
1417397209
Registry record updated Jun 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
2010040294 Issued in MO
Legal business name
COMMUNITY COUNSELING SERVICES OF MISSOURI, L.L.C.
Practice address
15423 McCloy Road
Licking, MO 65542-0111
Phone
(417) 260-7707
NPI assigned
Jun 26, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2013

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

Authorized official

Name
Mrs. Arlene J O'Brien, LPCNPI 1154766806
Title
Owner
Phone
(417) 260-7707

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X 2010040294 MO
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 2010040294 MO
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 2010040294 MO
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 2010040294 MO Primary

Addresses

Primary practice location

15423 McCloy Road
Licking, MO 65542-0111

Mailing address

PO Box 111
15423 McCloy Road
Licking, MO 65542-0111
Phone (417) 260-7707

Other identifiers 1

IdentifierTypeStateIssuer
1154766806MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190718003037 MO Part B Supplier - Clinic/Group Practice 4587999172 Receives reassigned benefits from 1 practitioner
Practice locations: Houston, MO

National Provider Directory

National Provider Directory
Tax ID family
Community Counseling Services of Missouri LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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": "1372204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372204800000",
    "number": "1417397209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 111",
            "address_2": "15423 MCCLOY ROAD",
            "city": "LICKING",
            "state": "MO",
            "postal_code": "655420111",
            "telephone_number": "417-260-7707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15423 MCCLOY ROAD",
            "city": "LICKING",
            "state": "MO",
            "postal_code": "655420111",
            "telephone_number": "417-260-7707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY COUNSELING SERVICES OF MISSOURI, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-26",
        "last_updated": "2013-06-26",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "ARLENE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-260-7707",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "MO",
            "license": "2010040294",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MO",
            "license": "2010040294",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "2010040294",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2010040294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154766806",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Licking, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.