Provider Demographics
NPI:1366795411
Name:PARENTING AND CHILD CONDUCT COUNSELING
Entity type:Organization
Organization Name:PARENTING AND CHILD CONDUCT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:636-699-0872
Mailing Address - Street 1:2850 WEST CLAY
Mailing Address - Street 2:SUITE 255
Mailing Address - City:ST. CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2579
Mailing Address - Country:US
Mailing Address - Phone:636-699-0872
Mailing Address - Fax:678-298-7523
Practice Address - Street 1:2850 WEST CLAY
Practice Address - Street 2:SUITE 255
Practice Address - City:ST CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2579
Practice Address - Country:US
Practice Address - Phone:636-699-0872
Practice Address - Fax:636-699-0872
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARENTING AND CHILD CONDUCT COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010008296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty