Organization
MONITEAU MENTAL HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLIE L SHUCK APRN-PMH (OWNER)
(573) 796-2905
Entity
Organization
Contact information
Practice address
320 S OAK ST, CALIFORNIA, MO 65018-1824
(573) 230-1037
Mailing address
PO BOX 5111, SPRINGFIELD, MO 65801-5111
(417) 429-2180
(417) 832-9799
Taxonomy
Speciality
Code
Description
License number
State
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
2000161947
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427531801
—
MO
Enumeration date
07/17/2008
Last updated
07/17/2008
Update your record
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