Healthcare Provider Details

I. General information

NPI: 1982875407
Provider Name (Legal Business Name): SOUTHEAST MISSOURI BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5536 HWY 32
FARMINGTON MO
63640-7357
US

IV. Provider business mailing address

PO BOX 506
PARK HILLS MO
63601-0506
US

V. Phone/Fax

Practice location:
  • Phone: 573-431-3341
  • Fax: 573-431-6580
Mailing address:
  • Phone: 573-431-0554
  • Fax: 573-431-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. BARRON E PRATTE
Title or Position: PRESIDENT/CEO
Credential: PH.D.
Phone: 573-431-0554