Healthcare Provider Details

I. General information

NPI: 1881731230
Provider Name (Legal Business Name): CLARK COMMUNITY MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 4TH ST
MONETT MO
65708-2316
US

IV. Provider business mailing address

307 4TH ST
MONETT MO
65708-2316
US

V. Phone/Fax

Practice location:
  • Phone: 417-235-6610
  • Fax: 417-236-0058
Mailing address:
  • Phone: 417-235-6610
  • Fax: 417-236-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2002007548
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CAROLYN B YOCUM
Title or Position: SOCIAL WORKER
Credential:
Phone: 417-235-6610