Organization
STATE OF MISSOURI
Active
Parent organization
STATE OF MISSOURI
Other names
Southeast MO Mental Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF MISSOURI
Authorized official
MOLLY JANE BOECKMANN (DIRECTOR OF ADMINISTRATIVE SERVICES)
(573) 751-4055
Entity
Organization
Contact information
Practice address
1010 W COLUMBIA ST, FARMINGTON, MO 63640-2902
(573) 218-6792
(573) 218-6703
Mailing address
1706 E ELM ST, JEFFERSON CITY, MO 65101-4130
(573) 751-3398
(573) 526-4560
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050490200
—
MO
Enumeration date
05/23/2006
Last updated
09/03/2020
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