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915 Southwest Blvd Ste E Jefferson City MO 65109-5014 | |
| (641) 485-0602 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 915 Southwest Blvd Ste E, Jefferson City, Missouri |
| Authorized Official Name and Position | Marcey L Smith (OWNER/THERAPIST) |
| Authorized Official Contact | 6414850602 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
915 Southwest Blvd Ste E Jefferson City MO 65109-5014 Ph: (641) 485-0602 | 915 Southwest Blvd Ste E Jefferson City MO 65109-5014 Ph: (641) 485-0602 |
| NPI Number | 1376248922 |
|---|---|
| Provider Enumeration Date | 04/03/2023 |
| Last Update Date | 06/12/2024 |
| Certification Date | 06/12/2024 |
| Medicare PECOS PAC ID | 6204378292 |
|---|---|
| Medicare Enrollment ID | O20240605003053 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376248922 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Marcey Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043726870 PECOS PAC ID: 4587107180 Enrollment ID: I20240605003040 |
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