MEDICARE: DSM PSYCHIATRIC SERVICES LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1891565180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DSM PSYCHIATRIC SERVICES LLC

Provider Business Mailing Address
First Line	:	203 S WASHINGTON ST
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1836
Country	:	US
Telephone Number	:	573-664-1047
Fax Number	:	573-218-0716

Provider Business Practice Location Address
First Line	:	203 S WASHINGTON ST
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1836
Country	:	US
Telephone Number	:	573-664-1047
Fax Number	:	573-218-0716

Authorized Official
Title or Position	:	OWNER
Name	:	DUSTIN SHANE MORTON
Credential	:	NP
Telephone Number	:	573-664-1047

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	02/29/2024

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