Provider Demographics
NPI:1285705855
Name:MIDWEST COUNSELING SERVICES
Entity type:Organization
Organization Name:MIDWEST COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILDA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC ICAADC
Authorized Official - Phone:636-299-2569
Mailing Address - Street 1:1000 EDGEWATER POINT
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LAKE ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367
Mailing Address - Country:US
Mailing Address - Phone:636-373-3236
Mailing Address - Fax:636-625-1633
Practice Address - Street 1:1000 EDGEWATER POINT
Practice Address - Street 2:SUITE 304
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367
Practice Address - Country:US
Practice Address - Phone:636-373-3236
Practice Address - Fax:636-625-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002017413101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty