MEDICARE: CLARK COMMUNITY MENTAL HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215080833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARK COMMUNITY MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	307 4TH ST
Second Line	:
City	:	MONETT
State	:	MO
Zip	:	65708-2316
Country	:	US
Telephone Number	:	417-235-3683
Fax Number	:	417-236-0058

Provider Business Practice Location Address
First Line	:	104 W MAIN ST
Second Line	:
City	:	PIERCE CITY
State	:	MO
Zip	:	65723-1210
Country	:	US
Telephone Number	:	417-476-1000
Fax Number	:	417-476-1082

Authorized Official
Title or Position	:	DIRECTOR OF ADMINISTRATION
Name	:	DEBBIE SCHOON
Credential	:
Telephone Number	:	417-476-1034

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	04/05/2024

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