Healthcare Provider Details

I. General information

NPI: 1982984365
Provider Name (Legal Business Name): REALITY HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E PRATHERSVILLE RD
COLUMBIA MO
65202-9260
US

IV. Provider business mailing address

PO BOX 1507
COLUMBIA MO
65205-1507
US

V. Phone/Fax

Practice location:
  • Phone: 573-449-8117
  • Fax: 573-874-1225
Mailing address:
  • Phone: 573-449-8117
  • Fax: 573-874-1225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS J WINFREY
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 573-449-8117