MEDICARE: PROACTIVE BEHAVIORAL HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1154144020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROACTIVE BEHAVIORAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	6389 HIGHWAY C
Second Line	:
City	:	PALMYRA
State	:	MO
Zip	:	63461-2044
Country	:	US
Telephone Number	:	217-242-7718
Fax Number	:	816-631-0171

Provider Business Practice Location Address
First Line	:	856 WATERBURY FALLS DR STE 102
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63368-2219
Country	:	US
Telephone Number	:	636-344-0433
Fax Number	:	816-631-0171

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RYAN W MORRIS
Credential	:
Telephone Number	:	217-242-7718

Provider Enumeration Date	:	11/07/2024
Last Update Date	:	03/20/2026

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