Healthcare Provider Details

I. General information

NPI: 1194024638
Provider Name (Legal Business Name): ALBANY BEHAVIORAL HEALTH SERVICES L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N SMITH ST
ALBANY MO
64402-1250
US

IV. Provider business mailing address

113 N SMITH ST
ALBANY MO
64402-1250
US

V. Phone/Fax

Practice location:
  • Phone: 660-853-1322
  • Fax:
Mailing address:
  • Phone: 660-853-1322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2010033597
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2003029038
License Number StateMO

VIII. Authorized Official

Name: JANE M WILMES
Title or Position: OWNER
Credential: LCSW
Phone: 660-853-1322