Organization
ENCOMPASSED PURPOSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRADLEY BERG PHD (EXECUTIVE DIRECTOR)
(573) 286-5625
Entity
Organization
Contact information
Practice address
52 PAVILION CIRCLE, MACKSCREEK, MO 65786
(573) 286-5625
Mailing address
52 PAVILION CIRCLE, MACKSCREEK, MO 65786
(573) 286-5625
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
175T00000X
Peer Specialist
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
01/02/2026
Last updated
01/02/2026
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