Organization
CAPITAL REGION MEDICAL CENTER
Active
Organization
CAPITAL REGION MEDICAL CENTER
Active
Other names
Capital Region Physicians - Center for Mental Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
TOM LUEBBERING (VP OF FINANCE)
(573) 632-5100
Entity
Organization
Contact information
Practice address
1432 SOUTHWEST BLVD, JEFFERSON CITY, MO 65109-2444
(573) 632-5560
(573) 632-5875
Mailing address
1432 SOUTHWEST BLVD, PO BOX 1128, JEFFERSON CITY, MO 65109-2444
(573) 632-5560
(573) 632-5875
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
505995001
—
MO
Enumeration date
09/19/2007
Last updated
08/23/2013
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