Provider Demographics
NPI:1972642304
Name:THE PROFESSIONAL COUNSELING GROUP, INC.
Entity type:Organization
Organization Name:THE PROFESSIONAL COUNSELING GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MELTON
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LPC
Authorized Official - Phone:573-624-6969
Mailing Address - Street 1:11437 S MAGNOLIA DR
Mailing Address - Street 2:P. O. BOX 826
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-9401
Mailing Address - Country:US
Mailing Address - Phone:573-624-6969
Mailing Address - Fax:573-624-5882
Practice Address - Street 1:11437 S MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-9401
Practice Address - Country:US
Practice Address - Phone:573-624-6969
Practice Address - Fax:573-624-5882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0033451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty