NPIMap

Organization Active NPI

Kybama, Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Bonne Terre, MO
National Provider Identifier
1437675477
Registry record updated Aug 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
KYBAMA, INC
Practice address
12729 Stoney Point Rd
Bonne Terre, MO 63628
Phone
(573) 358-8703
NPI assigned
Aug 22, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gary Selbert, LPC
Title
Program Director
Phone
(314) 960-8639

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

12729 Stoney Point Rd
Bonne Terre, MO 63628

Mailing address

PO Box 70
Potosi, MO 63664-0070

National Provider Directory

National Provider Directory
Tax ID family
Kybama Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503360000000",
    "number": "1437675477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636640070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12729 STONEY POINT RD",
            "city": "BONNE TERRE",
            "state": "MO",
            "postal_code": "63628",
            "telephone_number": "573-358-8703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KYBAMA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-22",
        "last_updated": "2017-08-22",
        "status": "A",
        "authorized_official_last_name": "SELBERT",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "314-960-8639",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonne Terre, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.