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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