Provider Demographics
NPI:1902253768
Name:OPTIONS OUTPAITENT COUNSELING SERVICE
Entity type:Organization
Organization Name:OPTIONS OUTPAITENT COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-782-7700
Mailing Address - Street 1:1010 W 10TH ST.
Mailing Address - Street 2:SUITE E
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 W 10TH ST.
Practice Address - Street 2:SUITE E
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801
Practice Address - Country:US
Practice Address - Phone:417-782-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1609948465Medicaid