MEDICARE: NORTHEAST MISSOURI HEALTH COUNCIL, 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	2003032101	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255510699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST MISSOURI HEALTH COUNCIL, INC.

Provider Business Mailing Address
First Line	:	1416 CROWN DRIVE
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-2548
Country	:	US
Telephone Number	:	660-627-5757
Fax Number	:	660-627-5802

Provider Business Practice Location Address
First Line	:	1510 CROWN DRIVE
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-2437
Country	:	US
Telephone Number	:	660-627-3621
Fax Number	:	660-627-5798

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ANDREW H GRIMM
Credential	:
Telephone Number	:	660-627-5757

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	02/17/2011

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