MEDICARE: PERCEPTION POINT SERVICES OF MISSOURI LLC

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

General Provider Information

NPI Number	:	1548816242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERCEPTION POINT SERVICES OF MISSOURI LLC

Provider Business Mailing Address
First Line	:	PO BOX 7479
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65205-7479
Country	:	US
Telephone Number	:	573-447-8388
Fax Number	:	573-447-7433

Provider Business Practice Location Address
First Line	:	1900 N PROVIDENCE RD STE 305
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3710
Country	:	US
Telephone Number	:	573-447-8388
Fax Number	:	573-447-7433

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	LAURA L MCMURRY
Credential	:	MSW LCSW
Telephone Number	:	573-447-8388

Provider Enumeration Date	:	08/18/2019
Last Update Date	:	08/16/2023

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