Provider Demographics
NPI:1326402694
Name:MARK TWAIN ASSOCIATION FOR MENTAL HEALTH, INC.
Entity Type:Organization
Organization Name:MARK TWAIN ASSOCIATION FOR MENTAL HEALTH, INC.
Other - Org Name:MARK TWAIN BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:573-600-9616
Mailing Address - Street 1:154 FORREST DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-5511
Mailing Address - Country:US
Mailing Address - Phone:573-221-2120
Mailing Address - Fax:573-221-4380
Practice Address - Street 1:154 FORREST DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-5511
Practice Address - Country:US
Practice Address - Phone:573-221-2120
Practice Address - Fax:573-221-4380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1447307004Medicaid
MO1417004094Medicaid
MO1700933363Medicaid
MO1043367626Medicaid
MO1184771149Medicaid
MO1447307004Medicaid