Derek Wayne Stricklin, PLPC
Individual provider Active NPI Emotionally Disturbed Childrens' Residential Treatment Facility · Fredericktown, MO
NPI 1598044083 · NPPES record last updated Aug 15, 2011
Key facts
- NPI
- 1598044083
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
- License
- 2011025373 (MO)
- Practice address
- 1800 Madison 257
Fredericktown, MO 63645-8273 - Phone
- (573) 783-4400
- Fax
- (573) 783-4409
- NPI assigned
- Aug 15, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tender Hearts Child Therapy Center, LLC
Practice addresses (Care Compare)
2909 Independence St
Cape Girardeau, MO 63703-5044
Phone (573) 803-1402
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231229002235 | MO | Practitioner - Mental Health Counselor | 7911357181 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2011025373 | MO | MD | Emotionally Disturbed Childrens' Residential Treatment Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Faith Tabernacle World Outreach Inc | Residential Treatment Facility, Emotionally Disturbed Children | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emotionally Disturbed Childrens' Residential Treatment Facility | 322D00000X | 2011025373 | MO | Yes |
Addresses
Primary practice location
1800 Madison 257
Fredericktown, MO 63645-8273
Mailing address
1800 Madison 257
Fredericktown, MO 63645-8273
Phone (573) 783-4400
Other providers in Fredericktown, MO
- Angela Dawn Silvey
- Nicole Sokolic
- Stephanie June Sooter
- Southeast Missouri Transportation Service, Inc.
- Lorna Dianne Stookey
- Brandi Nichole Tabor
- John Tedder
- Therapy With Rhonda Palmer LLC
- Carol Marie Thurman
- Judith A Thurmond
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 Aug 15, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.