Healthcare Provider Details

I. General information

NPI: 1144293549
Provider Name (Legal Business Name): EAST CENTRAL MISSOURI BEHAVIORAL HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 KELLEY PARKWAY
MEXICO MO
65265-2719
US

IV. Provider business mailing address

340 KELLEY PARKWAY
MEXICO MO
65265-2719
US

V. Phone/Fax

Practice location:
  • Phone: 573-582-1234
  • Fax: 573-581-1981
Mailing address:
  • Phone: 573-582-1234
  • Fax: 573-581-1981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number5726-7685
License Number StateMO

VIII. Authorized Official

Name: JEANANN EARLY
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 573-582-1234