# BOYS AND GIRLS TOWN MISSOURI

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013086842
- **Authorized official:** MR. GREG SHANK MSW, (THERAPIST)
- **Authorized official phone:** (417) 865-1646

## Contact information

- **Practice address:** 1212 W LOMBARD ST, SPRINGFIELD, MO 65806-2720
- **Practice address phone:** (417) 865-1646
- **Practice address fax:** (417) 866-1483
- **Mailing address:** 412 CARDINAL CT, NIXA, MO 65714-8848
- **Mailing address phone:** (417) 725-8684

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 2002002751 | MO | Yes |

## Other

- **Enumeration date:** 11/07/2006
- **Last updated:** 10/23/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 494901309 | — | MO |