Provider Demographics
NPI:1427347871
Name:4-SIGHT COUNSELING, INC.
Entity type:Organization
Organization Name:4-SIGHT COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:573-334-7995
Mailing Address - Street 1:937 BROADWAY ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-5493
Mailing Address - Country:US
Mailing Address - Phone:573-334-7995
Mailing Address - Fax:573-335-8610
Practice Address - Street 1:937 BROADWAY ST
Practice Address - Street 2:SUITE 305
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5493
Practice Address - Country:US
Practice Address - Phone:573-334-7995
Practice Address - Fax:573-335-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005012218251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495106445Medicaid
MO495106445Medicaid