Healthcare Provider Details

I. General information

NPI: 1770810269
Provider Name (Legal Business Name): RURAL MENTAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 N HIGHWAY 5
MANSFIELD MO
65704-7301
US

IV. Provider business mailing address

PO BOX 677
MANSFIELD MO
65704-0677
US

V. Phone/Fax

Practice location:
  • Phone: 417-924-2059
  • Fax: 417-924-2069
Mailing address:
  • Phone: 417-924-2059
  • Fax: 417-924-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2005028850
License Number StateMO

VIII. Authorized Official

Name: JANICE L MAY
Title or Position: PRESIDENT
Credential: PSYD
Phone: 417-343-3579