Provider Demographics
NPI:1053795005
Name:SOUTHEAST MISSOURI BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:SOUTHEAST MISSOURI BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR - ACCOUNTS MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FELKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-431-0554
Mailing Address - Street 1:512 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-2624
Mailing Address - Country:US
Mailing Address - Phone:573-431-0554
Mailing Address - Fax:573-431-1673
Practice Address - Street 1:512 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-2624
Practice Address - Country:US
Practice Address - Phone:573-431-0554
Practice Address - Fax:573-431-1673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health