Healthcare Provider Details

I. General information

NPI: 1093043481
Provider Name (Legal Business Name): ALLIANCE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S PREWITT ST
NEVADA MO
64772-1760
US

IV. Provider business mailing address

100 S PREWITT ST
NEVADA MO
64772-1760
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-8700
  • Fax: 417-667-7382
Mailing address:
  • Phone: 417-667-8700
  • Fax: 417-667-7382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: RANDY V NOBLE
Title or Position: OWNER
Credential: PSYD
Phone: 417-667-8700