Provider Demographics
NPI:1285949354
Name:ALPHA AND OMEGA CHRISTIAN COUNSELING OF JEFFERSON COUNTY, INC
Entity type:Organization
Organization Name:ALPHA AND OMEGA CHRISTIAN COUNSELING OF JEFFERSON COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATTON-CAGGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW/PHD
Authorized Official - Phone:636-376-8894
Mailing Address - Street 1:10626 BUSINESS 21 # 741
Mailing Address - Street 2:SUITEC
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-5039
Mailing Address - Country:US
Mailing Address - Phone:636-789-2747
Mailing Address - Fax:636-789-5815
Practice Address - Street 1:10626 BUSINESS 21 # 741
Practice Address - Street 2:SUITEC
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-5039
Practice Address - Country:US
Practice Address - Phone:636-789-2747
Practice Address - Fax:636-789-5815
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA&OMEGA CC OF JE CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-13
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00734251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1205932878OtherNPI INDUVIDUAL