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General NPI Number Information
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NPI Number | 1245493725
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTHCARE OF RURAL MISSOURI, INC
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Dates
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Enumeration Date | 07/06/2008
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Last Update Date | 07/06/2008
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Provider Practice Location Address
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Address Line | 808 SOUTH ST P.O. 432
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City | STOCKTON
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State | MO
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Zip | 65785-9112
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Country | US
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Telephone | 417-876-7267
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Fax |
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Provider Business Mailing Address
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Address Line | 808 SOUTH ST P.O. 432
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City | STOCKTON
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State | MO
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Zip | 65785-9112
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Country | US
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Telephone | 417-876-7267
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELLE LEA HOFFMANN
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Credential | PSY.D.
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Telephone | 417-816-7267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2006034113
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License Number State | MO
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