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General NPI Number Information
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NPI Number | 1902069552
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Entity Type | Organization
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Legal Business Name | LAKE AREA CITIZENS' ADVISORY BOARD, INC.
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 409R W US HIGHWAY 54
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City | CAMDENTON
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State | MO
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Zip | 65020-6948
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Country | US
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Telephone | 573-317-9061
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Fax | 573-317-1970
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Provider Business Mailing Address
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Address Line | 409R W US HIGHWAY 54
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City | CAMDENTON
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State | MO
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Zip | 65020-6948
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Country | US
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Telephone | 573-317-9061
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Fax | 573-317-1970
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Authorized Official
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Title or Position | BOARD PRESIDENT
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Name | MR. BRADLEY BERG
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Credential |
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Telephone | 573-317-9061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | MO
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