Provider Demographics
NPI:1689690984
Name:SOUTHEAST MISSOURI COMMUNITY TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHEAST MISSOURI COMMUNITY TREATMENT CENTER, INC.
Other - Org Name:SAME
Other - Org Type:Other Name
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MCLANE-LI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-686-5090
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-0506
Mailing Address - Country:US
Mailing Address - Phone:573-431-0554
Mailing Address - Fax:573-518-0329
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:573-518-0329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040350191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty