Provider Demographics
NPI:1699076265
Name:SUNRISE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:SUNRISE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:417-627-9800
Mailing Address - Street 1:2401 S JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1938
Mailing Address - Country:US
Mailing Address - Phone:417-627-9800
Mailing Address - Fax:417-627-9800
Practice Address - Street 1:2401 S JACKSON AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1938
Practice Address - Country:US
Practice Address - Phone:417-627-9800
Practice Address - Fax:417-627-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006036429101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494024300Medicaid