MEDICARE: BEHAVIORAL HEALTHCARE OF RURAL MISSOURI, INC

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	103TC0700X	Clinical Psychologist	2006034113	MO

General Provider Information

NPI Number	:	1245493725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL HEALTHCARE OF RURAL MISSOURI, INC

Provider Business Mailing Address
First Line	:	808 SOUTH ST
Second Line	:	P.O. 432
City	:	STOCKTON
State	:	MO
Zip	:	65785-9112
Country	:	US
Telephone Number	:	417-876-7267
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 SOUTH ST
Second Line	:	P.O. 432
City	:	STOCKTON
State	:	MO
Zip	:	65785-9112
Country	:	US
Telephone Number	:	417-876-7267
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHELLE LEA HOFFMANN
Credential	:	PSY.D.
Telephone Number	:	417-816-7267

Provider Enumeration Date	:	07/06/2008
Last Update Date	:	07/06/2008

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