Healthcare Provider Details

I. General information

NPI: 1730258930
Provider Name (Legal Business Name): NORTH CENTRAL MISSOURI MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 28TH ST
TRENTON MO
64683-1178
US

IV. Provider business mailing address

PO BOX 30
TRENTON MO
64683-0030
US

V. Phone/Fax

Practice location:
  • Phone: 660-359-4487
  • Fax: 660-359-2958
Mailing address:
  • Phone: 660-359-4487
  • Fax: 660-359-4129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number215-7709
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS LORYNE D. IRVINE
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, LCSW
Phone: 660-359-4487