Provider Demographics
NPI:1881849982
Name:CLARK COMMUNITY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:CLARK COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HELMKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-476-1035
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PIERCE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65723-2100
Mailing Address - Country:US
Mailing Address - Phone:417-476-1000
Mailing Address - Fax:417-476-1082
Practice Address - Street 1:104 WEST MAIN
Practice Address - Street 2:
Practice Address - City:PIERCE CITY
Practice Address - State:MO
Practice Address - Zip Code:65723
Practice Address - Country:US
Practice Address - Phone:417-476-1000
Practice Address - Fax:417-476-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008025261101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty