Organization
NORTH CENTRAL MISSOURI MENTAL HEALTH CENTER
Active
Organization
NORTH CENTRAL MISSOURI MENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS LORYNE D. IRVINE MA, LCSW (EXECUTIVE DIRECTOR)
(660) 359-4487
Entity
Organization
Contact information
Practice address
1601 E 28TH ST, TRENTON, MO 64683-1178
(660) 359-4487
(660) 359-2958
Mailing address
PO BOX 30, TRENTON, MO 64683-0030
(660) 359-4487
(660) 359-4129
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
215-7709
MO
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21371013
BLUE CROSS BLUE SHIELD
—
05
—
563012905
—
MO
Enumeration date
11/06/2006
Last updated
12/18/2020
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