| Table Rock Counseling, Llc | |
|
67 Bishop Ln Kimberling City MO 65686-9818 | |
| (417) 230-1279 | |
| (417) 739-1360 |
| Full Name | Table Rock Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 67 Bishop Ln, Kimberling City, Missouri |
| Authorized Official Name and Position | Laurie Jean Domsch (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 4172720055 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Table Rock Counseling, Llc 67 Bishop Ln Kimberling City MO 65686-9818 Ph: (417) 230-1279 | Table Rock Counseling, Llc 67 Bishop Ln Kimberling City MO 65686-9818 Ph: (417) 230-1279 |
| NPI Number | 1447231808 |
|---|---|
| Provider Enumeration Date | 11/10/2005 |
| Last Update Date | 05/13/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447231808 | NPI | - | NPPES |
| 1144201104 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | MO 004512 (Missouri) | Secondary |
| 104100000X | Social Worker | MO 004512 (Missouri) | Primary |