MEDICARE: SOUTHEAST MISSOURI COMMUNITY TREATMENT CENTER, 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	2000154535	MO

General Provider Information

NPI Number	:	1720261639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST MISSOURI COMMUNITY TREATMENT CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 506
Second Line	:	512 E. MAIN ST.
City	:	PARK HILLS
State	:	MO
Zip	:	63601-0506
Country	:	US
Telephone Number	:	573-431-0554
Fax Number	:	573-431-5205

Provider Business Practice Location Address
First Line	:	528 E MAIN ST
Second Line	:
City	:	PARK HILLS
State	:	MO
Zip	:	63601-2634
Country	:	US
Telephone Number	:	573-431-3341
Fax Number	:	573-431-5205

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	DR. BARRON E. PRATTE
Credential	:	PHD
Telephone Number	:	573-431-0554

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	12/13/2007

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