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General NPI Number Information
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NPI Number | 1558227751
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Entity Type | Organization
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Legal Business Name | MID-MISSOURI BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 12/31/2025
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 2100 E BROADWAY STE 108
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City | COLUMBIA
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State | MO
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Zip | 65201-6082
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Country | US
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Telephone | 571-438-5376
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 E BROADWAY STE 108
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City | COLUMBIA
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State | MO
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Zip | 65201-6082
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Country | US
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Telephone | 571-438-5376
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | COLIN DUGGAN
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Credential | PSYD
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Telephone | 571-438-5376
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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 |
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License Number State |
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