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General NPI Number Information
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NPI Number | 1619300233
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Entity Type | Organization
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Legal Business Name | ROCKET BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 3000 ALSUP DR
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City | COLUMBIA
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State | MO
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Zip | 65203-0802
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Country | US
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Telephone | 573-825-0233
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Fax | 573-447-7567
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Provider Business Mailing Address
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Address Line | PO BOX 30822
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City | COLUMBIA
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State | MO
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Zip | 65205-3822
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Country | US
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Telephone | 573-825-0233
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Fax | 573-447-7567
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMIE M SEVERTSON
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Credential | BCBAD
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Telephone | 573-825-0233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2011001018
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License Number State | MO
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