Provider Demographics
NPI:1144205527
Name:ALLIED MENTAL HEALTH ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ALLIED MENTAL HEALTH ASSOCIATES, INC.
Other - Org Name:ALLIED MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARLEY
Authorized Official - Middle Name:V
Authorized Official - Last Name:GULLETT
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW, LCSW
Authorized Official - Phone:417-667-8700
Mailing Address - Street 1:100 S PREWITT ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-1760
Mailing Address - Country:US
Mailing Address - Phone:417-667-8700
Mailing Address - Fax:417-667-7382
Practice Address - Street 1:100 S PREWITT ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-1760
Practice Address - Country:US
Practice Address - Phone:417-667-8700
Practice Address - Fax:417-667-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000175971101YP2500X
MO2003032134101YP2500X
MO2004037106101YP2500X
MO2004037100101YP2500X
MO2001029222101YP2500X
MO2000151808101YP2500X
MO2001014377103TC0700X
MO2000159804103TC0700X
MO01503103TC0700X
MO2004013232103TC0700X
MO0004401041C0700X
MO0006191041C0700X
MO0005341041C0700X
MO0007281041C0700X
MO101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOL430000Medicare ID - Type Unspecified