Healthcare Provider Details

I. General information

NPI: 1801807771
Provider Name (Legal Business Name): CLARK COMMUNITY MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N CENTRAL AVE
MONETT MO
65708-9999
US

IV. Provider business mailing address

PO BOX 100 104 W MAIN ST
PIERCE CITY MO
65723-2100
US

V. Phone/Fax

Practice location:
  • Phone: 417-476-1000
  • Fax: 471-476-1082
Mailing address:
  • Phone: 417-476-1000
  • Fax: 417-943-5693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2470-8563
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA SUPPLEE
Title or Position: PAYER ENROLLMENT MANAGER
Credential:
Phone: 417-476-1000