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General NPI Number Information
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NPI Number | 1699486506
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Entity Type | Organization
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Legal Business Name | KYBAMA, INC
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 12729 STONEY POINT RD
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City | BONNE TERRE
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State | MO
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Zip | 63628-5500
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Country | US
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Telephone | 573-631-2897
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Fax | 573-358-8727
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Provider Business Mailing Address
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Address Line | PO BOX 71
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City | POTOSI
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State | MO
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Zip | 63664-0071
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Country | US
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Telephone | 573-358-8703
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Fax | 573-358-8727
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Authorized Official
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Title or Position | PRESIDENT
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Name | LENNIE MICHAEL FINCHER
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Credential |
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Telephone | 573-631-2897
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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 |
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License Number State |
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