MEDICARE: PREFERRED BEHAVIORAL HEALTH MSO, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	2084P0800X	Psychiatry Physician
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1962014472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED BEHAVIORAL HEALTH MSO, INC.

Provider Business Mailing Address
First Line	:	141 MARKET PL STE 100
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2089
Country	:	US
Telephone Number	:	618-398-4226
Fax Number	:	618-398-1759

Provider Business Practice Location Address
First Line	:	141 MARKET PL STE 100
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2089
Country	:	US
Telephone Number	:	618-398-4226
Fax Number	:	618-398-1759

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

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	08/18/2020

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