Provider Demographics
NPI:1215577945
Name:MODERN MENTAL HEALTH
Entity Type:Organization
Organization Name:MODERN MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:JENE'
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-222-0096
Mailing Address - Street 1:151 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645
Mailing Address - Country:US
Mailing Address - Phone:573-222-0096
Mailing Address - Fax:573-240-8433
Practice Address - Street 1:151 SOUTH MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645
Practice Address - Country:US
Practice Address - Phone:573-222-0096
Practice Address - Fax:573-240-8433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health