Organization
SOUTHEAST MISSOURI BEHAVIORAL HEALTH
Active
Other names
Southeast Missouri Community Treatment Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARRON E PRATTE PH.D. (PRESIDENT CEO)
(573) 431-0554
Entity
Organization
Contact information
Practice address
143 S MAIN ST, IRONTON, MO 63650-1305
(573) 546-4005
(573) 546-4014
Mailing address
512 E MAIN ST, PO BOX 506, PARK HILLS, MO 63601-2624
(573) 431-0554
(573) 431-5205
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ADA-SDA4200052
PR PLUS CONTRACT PROVIDER WITH DMH
MO
Enumeration date
05/04/2010
Last updated
05/04/2010
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