| Omc Bhc Mh Crisis Prevention Project | |
|
1211 Porter Wagoner Blvd # 23 West Plains MO 65775-1826 | |
| (417) 257-6762 | |
| (417) 257-5875 |
| Full Name | Omc Bhc Mh Crisis Prevention Project |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 1211 Porter Wagoner Blvd # 23, West Plains, Missouri |
| Authorized Official Name and Position | Barrylyn Soundararajan (PROVIDER ENROLLMENT COORDINATOR) |
| Authorized Official Contact | 4172578752 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Omc Bhc Mh Crisis Prevention Project Po Box 1100 West Plains MO 65775-1100 Ph: () - | Omc Bhc Mh Crisis Prevention Project 1211 Porter Wagoner Blvd # 23 West Plains MO 65775-1826 Ph: (417) 257-6762 |
| NPI Number | 1619321643 |
|---|---|
| Provider Enumeration Date | 04/15/2016 |
| Last Update Date | 04/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619321643 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 174-57 (Missouri) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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