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129 E High St Suite A Jefferson City MO 65101-5401 | |
| (573) 761-3222 | |
| (573) 761-3222 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 129 E High St, Jefferson City, Missouri |
| Authorized Official Name and Position | Fred I Dudenhoeffer (PRESIDENT) |
| Authorized Official Contact | 5737613222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2168 Jefferson City MO 65102-2168 Ph: (573) 761-3222 | 129 E High St Suite A Jefferson City MO 65101-5401 Ph: (573) 761-3222 |
| NPI Number | 1699974063 |
|---|---|
| Provider Enumeration Date | 07/16/2007 |
| Last Update Date | 07/16/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699974063 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 1999137153 (Missouri) | Primary |
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