Organization
CLARK COMMUNITY MENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD RIDENOUR (CEO)
(417) 476-1000
Entity
Organization
Contact information
Practice address
104 W MAIN ST, PIERCE CITY, MO 65723-1210
(417) 476-1000
Mailing address
PO BOX 100, 104 W. MAIN, PIERCE CITY, MO 65723-2100
(417) 476-1000
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1784
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801807771
—
MO
Enumeration date
11/04/2016
Last updated
11/04/2016
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