Healthcare Provider Details

I. General information

NPI: 1528417581
Provider Name (Legal Business Name): COMMUNITY MENTAL HEALTH CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S ASH ST
NEVADA MO
64772-3222
US

IV. Provider business mailing address

815 S ASH ST
NEVADA MO
64772-3222
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-8352
  • Fax: 417-667-9216
Mailing address:
  • Phone: 417-667-8352
  • Fax: 417-667-9216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberADA ER2001006G1
License Number StateMO

VIII. Authorized Official

Name: MRS. JERRIE E STILES
Title or Position: OFFICE MANAGER
Credential:
Phone: 417-667-8352