Healthcare Provider Details

I. General information

NPI: 1952137861
Provider Name (Legal Business Name): PROACTIVE BEHAVIORAL HEALTH SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 WATERBURY FALLS DR STE 102
O FALLON MO
63368-2219
US

IV. Provider business mailing address

6389 HIGHWAY C
PALMYRA MO
63461-2044
US

V. Phone/Fax

Practice location:
  • Phone: 636-339-1190
  • Fax: 816-631-0171
Mailing address:
  • Phone: 217-242-7718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RYAN W MORRIS
Title or Position: PRESIDENT
Credential:
Phone: 217-242-7718