Healthcare Provider Details

I. General information

NPI: 1992988992
Provider Name (Legal Business Name): SOUTHEAST MISSOURI COMMUNITY TREATMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W 3RD ST APT A
WASHINGTON MO
63090-2320
US

IV. Provider business mailing address

PO BOX 506 512 E. MAIN ST.
PARK HILLS MO
63601-0506
US

V. Phone/Fax

Practice location:
  • Phone: 573-760-3874
  • Fax: 573-431-5205
Mailing address:
  • Phone: 573-431-0554
  • Fax: 573-431-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001751
License Number StateMO

VIII. Authorized Official

Name: DR. BARRON PRATTE
Title or Position: CEO/PRESIDENT
Credential: PHD
Phone: 573-431-0554