Ccbho | |
1706 E Elm St Jefferson City MO 65101-4130 | |
(573) 751-3398 | |
Not Available |
Full Name | Ccbho |
---|---|
Speciality | Community/behavioral Health |
Location | 1706 E Elm St, Jefferson City, Missouri |
Authorized Official Name and Position | Molly Jane Boeckmann (DIRECTOR OF ADMINISTRATIVE SERVICES) |
Authorized Official Contact | 5737514055 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Ccbho Po Box 687 1706 E Elm St Jefferson City MO 65102-0687 Ph: (573) 751-8157 | Ccbho 1706 E Elm St Jefferson City MO 65101-4130 Ph: (573) 751-3398 |
NPI Number | 1801422621 |
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Provider Enumeration Date | 03/13/2020 |
Last Update Date | 10/15/2020 |
Certification Date | 10/15/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1801422621 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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