Provider Demographics
NPI:1134492390
Name:SOUTHEAST MISSOURI BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:SOUTHEAST MISSOURI BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRON
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRATTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:573-431-0554
Mailing Address - Street 1:101 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-5843
Mailing Address - Country:US
Mailing Address - Phone:573-686-5090
Mailing Address - Fax:
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-5843
Practice Address - Country:US
Practice Address - Phone:573-686-5090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility