Provider Demographics
NPI:1063246072
Name:MISSOURI COMMUNITY COUNSELING ASSOCIATES
Entity type:Organization
Organization Name:MISSOURI COMMUNITY COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNOF
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, MBA
Authorized Official - Phone:314-991-0100
Mailing Address - Street 1:9666 OLIVE BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3026
Mailing Address - Country:US
Mailing Address - Phone:314-991-0100
Mailing Address - Fax:
Practice Address - Street 1:9666 OLIVE BLVD STE 510
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3026
Practice Address - Country:US
Practice Address - Phone:314-991-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)