Organization
BOYS AND GIRLS TOWN OF MISSOURI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALFAYE JACKSON PLPC (THERAPIST)
(573) 265-3251
Entity
Organization
Contact information
Practice address
13160 COUNTY RD 3610, ST. JAMES, MO 65559
(573) 265-3251
Mailing address
13160 COUNTY RD 3610, ST. JAMES, MO 65559
(573) 265-3251
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
2008015070
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2008015070
—
MO
Enumeration date
07/10/2008
Last updated
07/10/2008
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