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General NPI Number Information
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NPI Number | 1285489310
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Entity Type | Organization
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Legal Business Name | 5COR BEHAVIORAL HEALTH SERVICES LIMITED
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 119 ICHORD AVE
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City | WAYNESVILLE
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State | MO
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Zip | 65583-5401
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Country | US
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Telephone | 912-312-9632
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Fax |
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Provider Business Mailing Address
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Address Line | 144 RIDGEVIEW DR
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City | SAINT ROBERT
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State | MO
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Zip | 65584-8614
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Country | US
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Telephone | 912-312-3457
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANNA SCHROEDER
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Credential |
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Telephone | 912-312-3457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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