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General NPI Number Information
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NPI Number | 1770810269
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Entity Type | Organization
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Legal Business Name | RURAL MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 02/02/2010
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Provider Practice Location Address
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Address Line | 812 N HIGHWAY 5
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City | MANSFIELD
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State | MO
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Zip | 65704-7301
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Country | US
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Telephone | 417-924-2059
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Fax | 417-924-2069
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Provider Business Mailing Address
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Address Line | PO BOX 677
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City | MANSFIELD
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State | MO
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Zip | 65704-0677
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Country | US
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Telephone | 417-924-2059
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Fax | 417-924-2069
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANICE L MAY
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Credential | PSYD
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Telephone | 417-343-3579
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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 | 2005028850
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License Number State | MO
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