Healthcare Provider Details

I. General information

NPI: 1558227751
Provider Name (Legal Business Name): MID-MISSOURI BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 E BROADWAY STE 108
COLUMBIA MO
65201-6082
US

IV. Provider business mailing address

2100 E BROADWAY STE 108
COLUMBIA MO
65201-6082
US

V. Phone/Fax

Practice location:
  • Phone: 571-438-5376
  • Fax:
Mailing address:
  • Phone: 571-438-5376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: COLIN DUGGAN
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 571-438-5376