Bethany Christian Services

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

001523 Issued in MO

Legal business name

BETHANY CHRISTIAN SERVICES

Practice address

210 E Washington St
Jackson, MO 63755-1448

Phone

(573) 204-8800

Fax

(573) 204-8833

NPI assigned

Aug 6, 2008

Last updated

Aug 6, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donna Nicholson, MA, LPC

Title

Missouri Branch Director

Phone

(314) 781-6363

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1217980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217980800000",
    "number": "1770749079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637550207",
            "telephone_number": "573-204-8800",
            "fax_number": "573-204-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E WASHINGTON ST",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637551448",
            "telephone_number": "573-204-8800",
            "fax_number": "573-204-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY CHRISTIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-06",
        "last_updated": "2008-08-06",
        "status": "A",
        "authorized_official_last_name": "NICHOLSON",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "MISSOURI BRANCH DIRECTOR",
        "authorized_official_telephone_number": "314-781-6363",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "001523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780777250",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2008; 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.