Provider Demographics
NPI:1104996750
Name:ASSOCIATED COUNSELING SERVICES, INC.
Entity type:Organization
Organization Name:ASSOCIATED COUNSELING SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW, LPC
Authorized Official - Phone:573-335-7929
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-0645
Mailing Address - Country:US
Mailing Address - Phone:573-335-7929
Mailing Address - Fax:573-335-6445
Practice Address - Street 1:1221 N KINGSHIGHWAY ST
Practice Address - Street 2:IMPERIAL BUILDING
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-3506
Practice Address - Country:US
Practice Address - Phone:573-335-7929
Practice Address - Fax:573-335-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
759297OtherHEALTHLINK