| NPI | 1144932567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRIAM BURCH Billing Clerk 573-642-5345 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2022-12-16 |
| Last Update Date | 2022-12-23 |