| Prairie Mental Health Services, Llc | |
|
417 W Young Ave Warrensburg MO 64093-1113 | |
| (660) 747-4700 | |
| (660) 747-4701 |
| Full Name | Prairie Mental Health Services, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 417 W Young Ave, Warrensburg, Missouri |
| Authorized Official Name and Position | Bruce Andrew Fletcher (CHIEF ECXECUTIVE OFFICER) |
| Authorized Official Contact | 6607474700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Mental Health Services, Llc Po Box 1547 Sedalia MO 65302-1547 Ph: (660) 826-5960 | Prairie Mental Health Services, Llc 417 W Young Ave Warrensburg MO 64093-1113 Ph: (660) 747-4700 |
| NPI Number | 1780947150 |
|---|---|
| Provider Enumeration Date | 06/20/2012 |
| Last Update Date | 06/06/2023 |
| Certification Date | 06/06/2023 |
| Medicare PECOS PAC ID | 7719133404 |
|---|---|
| Medicare Enrollment ID | O20120813000403 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780947150 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Bruce Fletcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932472610 PECOS PAC ID: 8628224318 Enrollment ID: I20120813000464 |
| Provider Name | Shannon E Wilkinson |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1639330863 PECOS PAC ID: 6800250119 Enrollment ID: I20230919002785 |
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