Southeast Missouri Behavioral Health
Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Ironton, MO
NPI 1831417682 · NPPES record last updated May 4, 2010
Key facts
- NPI
- 1831417682
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
- Legal business name
- SOUTHEAST MISSOURI BEHAVIORAL HEALTH
- Practice address
- 143 S Main St
Ironton, MO 63650-1305 - Phone
- (573) 546-4005
- Fax
- (573) 546-4014
- NPI assigned
- May 4, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Barron E Pratte, PH.D.
- Title
- President Ceo
- Phone
- (573) 431-0554
Corporate family (same tax ID) 14
National Provider Directory
- Tax ID family
- Southeast Missouri Behavioral Health
Locations
143 S Main St
Ironton, MO 63650
Phone (573) 546-4005
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | Yes |
Addresses
Primary practice location
143 S Main St
Ironton, MO 63650-1305
Mailing address
512 E Main St
PO Box 506
Park Hills, MO 63601-2624
Phone (573) 431-0554
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ADA-SDA4200052 | Other | MO | PR PLUS CONTRACT PROVIDER WITH DMH |
Other names
- Southeast Missouri Community Treatment Center
Other providers in Ironton, MO
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- Erika Michelle Parks
- Scenic View LLC
- Christopher Shawn Skinner
- Melissa Ann Stetina
- The Baptist Home
- The Baptist Home
- Valley Chiropractic Center, Inc.
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All providers in Ironton, MO · Substance Use Disorder Rehabilitation Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.