Healthcare Provider Details

I. General information

NPI: 1255033692
Provider Name (Legal Business Name): AVENUES OF MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARTON COUNTY HEATH DEPARTMENT 1301 EAST 12TH STREET
LAMAR MO
64759
US

IV. Provider business mailing address

1203 E 18TH ST
LAMAR MO
64759-2416
US

V. Phone/Fax

Practice location:
  • Phone: 417-214-3966
  • Fax:
Mailing address:
  • Phone: 417-214-3966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. NANCY GAYLE JAMERSON
Title or Position: OWNER
Credential: LCSW
Phone: 417-214-3966