| Northeast Missouri Behavioral Health | |
|
159 E Commercial St Kahoka MO 63445-1701 | |
| (660) 627-3621 | |
| (660) 627-5798 |
| Full Name | Northeast Missouri Behavioral Health |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 159 E Commercial St, Kahoka, Missouri |
| Authorized Official Name and Position | Marilyn Green (EXECUTIVE ASSISTANT) |
| Authorized Official Contact | 6606275757 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Missouri Behavioral Health 1416 Crown Dr Kirksville MO 63501-2548 Ph: (660) 627-5757 | Northeast Missouri Behavioral Health 159 E Commercial St Kahoka MO 63445-1701 Ph: (660) 627-3621 |
| NPI Number | 1548588932 |
|---|---|
| Provider Enumeration Date | 05/10/2010 |
| Last Update Date | 06/17/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548588932 | NPI | - | NPPES |
| 1104147552 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 2010017942 (Missouri) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Missouri) | Primary |