Provider Demographics
NPI:1922163781
Name:JCMG MENTAL HEALTH, L.L.C.
Entity Type:Organization
Organization Name:JCMG MENTAL HEALTH, L.L.C.
Other - Org Name:JANE DOMKE, PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIGHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-556-7776
Mailing Address - Street 1:701 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-1525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 W HIGH ST
Practice Address - Street 2:ROOM 14
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-1525
Practice Address - Country:US
Practice Address - Phone:573-636-3313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty