Healthcare Provider Details

I. General information

NPI: 1609194448
Provider Name (Legal Business Name): SOUTHEAST MISSOURI BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 PIEDMONT AVE STE 304
PIEDMONT MO
63957-1017
US

IV. Provider business mailing address

512 E MAIN ST PO BOX 506
PARK HILLS MO
63601-2624
US

V. Phone/Fax

Practice location:
  • Phone: 573-223-2734
  • Fax: 573-223-2764
Mailing address:
  • Phone: 573-431-0554
  • Fax: 573-431-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BARRON E PRATTE
Title or Position: PRESIDENT CEO
Credential: PH.D.
Phone: 573-431-0554