| Eagle Crest Counseling Center, Inc. | |
|
636 W Republic Rd Ste F100 Springfield MO 65807-5810 | |
| (417) 862-8282 | |
| (417) 862-8805 |
| Full Name | Eagle Crest Counseling Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 636 W Republic Rd Ste F100, Springfield, Missouri |
| Authorized Official Name and Position | Jim W. Cherry (OFFICE MANAGER) |
| Authorized Official Contact | 4178628282 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagle Crest Counseling Center, Inc. 636 W Republic Rd Ste G100 Springfield MO 65807-5811 Ph: (417) 862-8282 | Eagle Crest Counseling Center, Inc. 636 W Republic Rd Ste F100 Springfield MO 65807-5810 Ph: (417) 862-8282 |
| NPI Number | 1659421931 |
|---|---|
| Provider Enumeration Date | 01/11/2007 |
| Last Update Date | 03/01/2022 |
| Certification Date | 02/28/2022 |
| Medicare PECOS PAC ID | 3779631619 |
|---|---|
| Medicare Enrollment ID | O20090501000337 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659421931 | NPI | - | NPPES |
| 500792502 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (NU) | Primary |
| Provider Name | Debbie L Cherry |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477603769 PECOS PAC ID: 1850449794 Enrollment ID: I20100913000086 |
| Provider Name | Jeffrey a Alderman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063860195 PECOS PAC ID: 7911355144 Enrollment ID: I20231129001941 |
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