| |
27 Hopper Trl Urbana MO 65767-9234 | |
(417) 722-4416 | |
(417) 722-4417 |
Full Name | |
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Speciality | Counselor - Mental Health |
Location | 27 Hopper Trl, Urbana, Missouri |
Authorized Official Name and Position | Gary D Boggs (PRESIDENT) |
Authorized Official Contact | 4177224416 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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27 Hopper Trl Urbana MO 65767-9234 Ph: (417) 722-4416 | 27 Hopper Trl Urbana MO 65767-9234 Ph: (417) 722-4416 |
NPI Number | 1871638999 |
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Provider Enumeration Date | 02/20/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1871638999 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | 91438201670000 (Missouri) | Primary |