Healthcare Provider Details

I. General information

NPI: 1285489310
Provider Name (Legal Business Name): 5COR BEHAVIORAL HEALTH SERVICES LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 ICHORD AVE
WAYNESVILLE MO
65583-5401
US

IV. Provider business mailing address

144 RIDGEVIEW DR
SAINT ROBERT MO
65584-8614
US

V. Phone/Fax

Practice location:
  • Phone: 912-312-9632
  • Fax:
Mailing address:
  • Phone: 912-312-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANNA SCHROEDER
Title or Position: OFFICE MANAGER
Credential:
Phone: 912-312-3457