# KYBAMA, INC

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

## Provider details

- **NPI number:** 1437675477
- **Authorized official:** GARY SELBERT LPC (PROGRAM DIRECTOR)
- **Authorized official phone:** (314) 960-8639

## Contact information

- **Practice address:** 12729 STONEY POINT RD, BONNE TERRE, MO 63628
- **Practice address phone:** (573) 358-8703
- **Mailing address:** PO BOX 70, POTOSI, MO 63664-0070

## Taxonomy

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

## Other

- **Enumeration date:** 08/22/2017
- **Last updated:** 08/22/2017