Organization
MISSOURI DEPARTMENT OF MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNNE FULKS (DIRECTOR OF ADMINISTRATIVE SERVICES)
(573) 751-8142
Entity
Organization
Contact information
Practice address
1706 E ELM ST, JEFFERSON CITY, MO 65101-4130
(573) 751-2940
Mailing address
1706 E ELM ST, JEFFERSON CITY, MO 65101-4130
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
05/25/2016
Last updated
08/26/2019
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