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General NPI Number Information
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NPI Number | 1952137861
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Entity Type | Organization
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Legal Business Name | PROACTIVE BEHAVIORAL HEALTH SOLUTIONS, INC.
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 1654 BRYAN RD
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City | O FALLON
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State | MO
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Zip | 63368-4897
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Country | US
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Telephone | 636-344-0433
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Fax |
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Provider Business Mailing Address
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Address Line | 6389 HIGHWAY C
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City | PALMYRA
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State | MO
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Zip | 63461-2044
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Country | US
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Telephone | 217-242-7718
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RYAN W MORRIS
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Credential |
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Telephone | 217-242-7718
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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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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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