Provider Demographics
NPI:1699974063
Name:F.D. PROFESSIONAL COUNSELING SERVICE, INC
Entity type:Organization
Organization Name:F.D. PROFESSIONAL COUNSELING SERVICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:I
Authorized Official - Last Name:DUDENHOEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-761-3222
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65102-2168
Mailing Address - Country:US
Mailing Address - Phone:573-761-3222
Mailing Address - Fax:573-761-3222
Practice Address - Street 1:129 E HIGH ST
Practice Address - Street 2:SUITE A
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-5401
Practice Address - Country:US
Practice Address - Phone:573-761-3222
Practice Address - Fax:573-761-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999137153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty