NPIMap

Organization Active NPI

Benton Street Counseling LLC

  • Professional Counselor
  • Rolla, MO
National Provider Identifier
1578053955
Registry record updated May 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
2017011362 Issued in MO
Legal business name
BENTON STREET COUNSELING LLC
Practice address
1030 Kingshighway St Ste a
Rolla, MO 65401-2930
Phone
(573) 458-9920
Fax
(573) 433-2829
NPI assigned
May 11, 2018
Last updated
May 11, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2018

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

Authorized official

Name
Mary Ann Wyatt, LPCNPI 1710252333
Title
Member
Phone
(573) 433-2833

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 000281 MO
Professional Counselor 101YP2500X 2017011362 MO Primary
Clinical Social Worker 1041C0700X 2010036135 MO

Addresses

Primary practice location

1030 Kingshighway St Ste a
Rolla, MO 65401-2930

Mailing address

1030 Kingshighway St Ste a
Rolla, MO 65401-2930
Phone (573) 458-9920

Other practice location 1

119 N Benton St
Waynesville, MO 65583-2501
Phone (573) 433-2833

Other practice location 2

89 McCrory Drive
Camdenton, MO 65020
Phone (573) 525-7071

National Provider Directory

National Provider Directory
Tax ID family
Benton Street Counseling 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.

Locations

89 McCrory Ave
Camdenton, MO 65020
Phone (573) 433-2833

1030 Kingshighway St
Ste A
Rolla, MO 65401
Phone (573) 458-9920

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1525996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525996800000",
    "number": "1578053955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 KINGSHIGHWAY ST STE A",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012930",
            "telephone_number": "573-458-9920",
            "fax_number": "573-433-2829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 KINGSHIGHWAY ST STE A",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012930",
            "telephone_number": "573-458-9920",
            "fax_number": "573-433-2829"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "119 N Benton St",
            "address_purpose": "LOCATION",
            "city": "Waynesville",
            "state": "MO",
            "postal_code": "655832501",
            "country_code": "US",
            "telephone_number": "573-433-2833",
            "fax_number": "573-433-2829",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "89 McCrory Drive",
            "address_purpose": "LOCATION",
            "city": "Camdenton",
            "state": "MO",
            "postal_code": "65020",
            "country_code": "US",
            "telephone_number": "573-525-7071",
            "fax_number": "573-525-7072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BENTON STREET COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-11",
        "last_updated": "2018-05-11",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "573-433-2833",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "000281",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2017011362",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2010036135",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rolla, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2018; 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.