Organization
KYBAMA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY SELBERT LPC (PROGRAM DIRECTOR)
(314) 960-8639
Entity
Organization
Contact information
Practice address
12729 STONEY POINT RD, BONNE TERRE, MO 63628
(573) 358-8703
Mailing address
PO BOX 70, POTOSI, MO 63664-0070
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/22/2017
Last updated
08/22/2017
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