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General NPI Number Information
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NPI Number | 1255510699
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Entity Type | Organization
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Legal Business Name | NORTHEAST MISSOURI HEALTH COUNCIL, INC.
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 1510 CROWN DRIVE
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City | KIRKSVILLE
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State | MO
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Zip | 63501-2437
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Country | US
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Telephone | 660-627-3621
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Fax | 660-627-5798
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Provider Business Mailing Address
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Address Line | 1416 CROWN DRIVE
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City | KIRKSVILLE
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State | MO
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Zip | 63501-2548
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Country | US
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Telephone | 660-627-5757
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Fax | 660-627-5802
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANDREW H GRIMM
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Credential |
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Telephone | 660-627-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2003032101
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License Number State | MO
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